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Multicenter Study
. 2023 Jan 10;7(1):e0002.
doi: 10.1097/HC9.0000000000000002. eCollection 2023 Jan 1.

Impact of fentanyl analgesia on the accuracy of HVPG measurements in patients with cirrhosis: a prospective, multicenter study

Haijun Zhang  1 , Lili Yang  2 , Ziniu Yu  3 , Dan Li  4 , Lei Li  5 , Shuangxi Li  5 , Jun Yan  6   7 , Xun Li  1   6   7   8
Affiliations
Multicenter Study

Impact of fentanyl analgesia on the accuracy of HVPG measurements in patients with cirrhosis: a prospective, multicenter study

Haijun Zhang et al. Hepatol Commun. .

Abstract

Background: HVPG measurement is the gold standard for assessing portal hypertension. Many patients decline HVPG measurements due to associated pain. According to previous studies, propofol sedation during HVPG measurements potentially alters HVPG readings. However, opioid analgesics' effects on HVPG await full elucidation. This study aimed to evaluate fentanyl analgesia's effects on HVPG measurement accuracy in patients with cirrhosis.

Methods: This prospective, multicenter study included patients with cirrhosis undergoing HVPG measurements, which were performed preanalgesia and under analgesia with fentanyl injection (1.0 or 1.5 μg/kg).

Results: Of the 48 enrolled patients with cirrhosis, 23 were administered 1.0 μg/kg fentanyl analgesia during HVPG measurement. The HVPG was 13.4±4.9 mm Hg in preanalgesia and 13.5±5.2 mm Hg under analgesia. HVPG measurement accuracy was not altered after fentanyl analgesia (p = 0.801). The following measures also did not change: heart rate (p = 0.132), mean arterial pressure (p = 0.348), and blood oxygen saturation (p = 0.748); however, respiratory rate (p = 0.001) changes occurred. The Verbal Numerical Rating Score for comfort under analgesia was higher than that in preanalgesia (p = 0.001). Twenty-five patients were administered 1.5 μg/kg fentanyl analgesia during HVPG measurement. The HVPG was 19.5±5.7 mm Hg in preanalgesia and 19.6±5.6 mm Hg under analgesia. HVPG measurement accuracy did not alter after fentanyl analgesia (p = 0.469). Similarly, the following measures did not change: mean arterial pressure (p = 0.871) and oxygen saturation (p = 0.327); nevertheless, respiratory rate (p = 0.015) and heart rate (p = 0.019) changes occurred. The Verbal Numerical Rating Score for comfort under analgesia was higher than that in preanalgesia (p < 0.001).

Conclusion: Fentanyl analgesia did not alter HVPG measurement accuracy, and fentanyl improved comfort in patients with cirrhosis during HVPG measurements.

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Conflict of interest statement

Nothing to report.

Figures

FIGURE 1
FIGURE 1
Hemodynamic, respiratory, and Verbal Numerical Rating Score-for-comfort changes with 1.0-μg/kg fentanyl analgesia administration for HVPG measurement.
FIGURE 2
FIGURE 2
Representative hepatic vein pressure was registered during the preanalgesia (A) and under-analgesia (B) states with 1.0 µg/kg fentanyl administration, and no marked oscillation of HVPG readings was observed during HVPG measurement.
FIGURE 3
FIGURE 3
Correlation between the preanalgesia and under-analgesia HVPG with 1.0 µg/mg fentanyl administration. (A) The scatterplot shows the agreement between the preanalgesia and under-analgesia HVPG. (B) The Bland–Altman plot shows the difference between the preanalgesia and under-analgesia HVPG.
FIGURE 4
FIGURE 4
Hemodynamic, respiratory, and Verbal Numerical Rating Score-for-comfort changes with 1.5-μg/kg fentanyl analgesia administration for HVPG measurement.
FIGURE 5
FIGURE 5
Representative hepatic vein pressure was registered during the preanalgesia (A) and under-analgesia (B) states with 1.5 µg/kg fentanyl administration, and no marked oscillation of HVPG readings was observed.
FIGURE 6
FIGURE 6
Correlation between the pre-analgesia and under-analgesia HVPG with 1.5 µg/mg fentanyl administration. (A) The scatterplot shows the agreement between the pre-analgesia and under-analgesia HVPG. (B) The Bland–Altman plot shows the difference between the pre-analgesia and under-analgesia HVPG.
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