Incidence and risk factor analysis of moderate-to-severe pain after preoperative CT-guided hook-wire puncture localisation of pulmonary nodules
Authors: Pan Jiajian , Feng Tianci , Ge Yong , Sun Teng , Feng Shoujie , Zhang Cheng , Zhang Hao 
Published: September 2024

Background Pain is a relatively common complication after hook-wire puncture localisation. However, the problem of pain occurrence following this localisation procedure has not been sufficiently examined. In this prospective study, we aimed to investigate the incidence and risk factors associated with acute pain after preoperative CT-guided hook-wire puncture localisation of pulmonary nodules.
Methods Clinical data were collected prospectively from patients with small pulmonary nodules who underwent preoperative CT-guided hook-wire puncture localisation between May 2022 and May 2023 at the Affiliated Hospital of Xuzhou Medical University. Patients were divided into two groups on the basis of the presence or absence of moderate-to-severe pain following the localisation process. Univariate logistic analysis was conducted to analyse the clinical data of the two groups. Subsequently, the significant variables (P < 0.1) from the univariate analysis were subjected to multivariate logistic analysis, followed by the establishment of regression equations to determine the significant risk factors related to moderate-to-severe pain after hook-wire puncture localisation.
Results A total of 281 patients with small pulmonary nodules undergoing preoperative CT-guided hook-wire puncture localisation were finally included, with a mean age of 54.86 years (SD = 12.1 years) and female predominance (67.6%). In the resting state, 27.7% of the patients reported moderate-to-severe pain, which increased to 53% during activity. Univariate analysis reveald that age (P = 0.085), the depth of localisation needle insertion into the lung (P = 0.024) and the location of the chest wall puncture (P = 0.07) were associated with moderate-to-severe pain occurrence during activity after hook-wire puncture localisation (P < 0.1). Furthermore, multivariate logistic regression analysis demonstrated that the depth of localisation needle insertion into the lung (OR = 0.953, 95% CI: 0.914–0.992, P = 0.02) and the location of the chest wall puncture (lateral chest wall vs anterior chest wall: OR = 2.101, 95% CI: 1.166–3.784, P = 0.013; posterior chest wall vs anterior chest wall: OR = 1.163, 95% CI: 0.895–2.971, P = 0.11) were independent predictors of moderate-to-severe pain incidence during activity following CT-guided hook-wire puncture localisation (P < 0.05).
Conclusion Moderate-to-severe pain is prevalent in patients with pulmonary nodules who undergo preoperative CT-guided hook-wire puncture localisation. The depth of needle insertion into the lung and the location of the chest wall puncture are significant predictors of moderate-to-severe pain onset. Additionally, the depth of localisation needle insertion into the lung is inversely proportional to the risk of moderate-to-severe pain. Finally, hook-wire puncture localisation in the lateral chest wall should be avoided to reduce the incidence of moderate-to-severe pain in patients.