Pain after percutaneous liver biopsy for diffuse hepatic disease: A randomized trial comparing subcostal and intercostal approaches

PURPOSE: To compare pain levels as measured by visual analog scale (VAS) and analgesic requirement between intercostal and anterior subcostal ultrasound (US)-guided biopsy. MATERIALS AND METHODS: Seventy consecutive patients were randomized to undergo biopsy via an intercostal (n = 33) or subcostal (n = 37) approach. The groups were matched with regard to baseline characteristics: mean age, 44 years; age range, 20-70 years; sex, 43 male and 27 female; and indications of hepatitis C in 69%, hepatitis B in 16%, and others in 15%. The VAS score was obtained immediately after biopsy and hourly for 4 hours until the patients were discharged. Analgesic requirements and postprocedural complications were documented. RESULTS: No significant difference in VAS scores was seen between the groups. At hours 0, 1, 2, 3, and 4, the VAS scores (on a scale of 100) in the intercostal and subcostal groups were 10.3 +/- 16.7 versus 11.8 +/- 16.0 (P=.70), 19.1 +/- 24.0 versus 13.9 +/- 16.2 (P =.30), 11.5 +/- 14.8 versus 11.8 +/- 15.1 (P=.93), 6.2 +/- 8.9 versus 7.5 +/- 11.5 (P=.63), and 5.4 +/- 8.2 versus 4.7 +/- 8.5 (P=.72), respectively. The average VAS was less than 10. In the intercostal biopsy group, 36.4% of patients required additional analgesia after biopsy, compared with 27.0% in the subcostal biopsy group (P=.64). One patient in the intercostal group refused to have future follow-up biopsy even if it was clinically indicated, compared with no such patients in the subcostal biopsy group. No differences in diagnostic samples or major complications were seen in either group. CONCLUSION: US-guided percutaneous liver biopsy performed with fentanyl and midazolam premedication is a well-tolerated procedure with minimal patient discomfort. The location of the biopsy does not influence the outcome of the procedure.