Hepatic chemoembolization (
HCE) routinely results in severe
pain requiring massive doses of intravenously administered
narcotics. This study examines the efficacy and safety of
lidocaine administered intraarterially for
analgesia in
HCE. In 45
HCE procedures,
lidocaine was injected into hepatic arterial branches just prior to and during chemoembolization. Adjunctive
analgesic doses given during the procedure and the need for a
morphine sulfate drip infusion for postprocedural
pain control were recorded and compared with those in 20 procedures performed previously without
lidocaine. In procedures with
lidocaine, an average of 0.13 mg of
morphine sulfate and 1.3 mg of
midazolam were required. This is significantly lower than the 11.7 mg of
morphine sulfate and 3.7 mg of
midazolam used during procedures without
lidocaine. A postprocedural
morphine drip infusion was required for control of severe
pain in 16 of 20 (80%) procedures performed without
lidocaine compared with nine of 45 (20%) of those performed with
lidocaine. Peripheral blood levels of
lidocaine were well below the toxic level, and no complications referable to
lidocaine toxicity occurred. Marked reductions in the amount of
narcotic analgesia in
HCE procedures may be safely achieved with the administration of intraarterial
lidocaine.