Effect of Esketamine on Abdominal Pain During TACE-HAIC in Patients With Hepatocellular Carcinoma

Study Overview
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Brief Summary
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Previous studies have confirmed that limb pain caused by oxaliplatin chemotherapy is related to spinal cord central sensitization - induced hyperalgesia through oxaliplatin activating spinal cord NMDA receptor(N-methyl-D-aspartic acid receptor). The investigators speculate that this may be the same as the mechanism of severe abdominal pain caused by HAIC(Hepatic Artery Infusion Chemotherapy) during oxaliplatin infusion. The analgesic effect of Esketamine is mainly related to its inhibition of NMDA receptor in spinal cord. Therefore, this study hypothesized that Esketamine can inhibit the sensitization of spinal cord center by inhibiting NMDA receptor, so as to alleviate severe abdominal pain during HAIC perfusion, and reduce abdominal pain caused by ischemia and inflammation by TACE(transcatheter arterial chemoembolization) by improving organ perfusion and anti-inflammatory effect, Therefore, it is expected that Esketamine can better alleviate acute severe abdominal pain caused by TACE-HAIC (transcatheter arterial chemoembolization combined with Hepatic Artery Infusion Chemotherapy )treatment than sufentanil, decrease the dosage of opioids, and reduce the incidence and degree of chronic abdominal pain after treatment.

Official Title
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Effect of Esketamine on Abdominal Pain During TACE-HAIC in Patients With Hepatocellular Carcinoma: a Prospective Study TACE-HAIC (Transcatheter Arterial Chemoembolization Combined With Hepatic Artery Infusion Chemotherapy )

Conditions
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Hepatocellular Carcinoma, Transarterial Chemoembolization, Hepatic Arterial Infusion Chemotherapy, Pain

Intervention / Treatment
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* Drug: Esketamine
* Drug: Sufentanil


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participate in this study and sign informed consent Voluntarily receive postoperative intravenous controlled analgesia Patients receiving TACE-HAIC treatment HCC (hepatocellular carcinoma)patients with primary liver cancer BCLC(Barcelona Clinic Liver Cancer) stage B and C, liver function A Age 18 to 80 Exclusion Criteria: Patients who were unable to cooperate or refused to participate in the trial Pregnant women Patients with sensory abnormalities such as diabetes neuropathy Patients with or having a history of serious mental disorders Patients with poorly controlled or untreated hypertension (arterial hypertension, resting systolic / diastolic blood pressure more than 180/100mg) Patients with unstable angina pectoris or myocardial infarction within 6 months or congestive heart failure Patients with intracranial hypertension or glaucoma Patients with hyperthyroidism without treatment or insufficient treatment Patients with severe respiratory dysfunction Allergy or existing contraindication to chemotherapeutic drugs, opioids or ketamine drugs Can not follow with the study procedure

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Esketamine-PCIA(patient controlled intravenous analgesia)<br>PCIA formula：100ml analgesic solution was prepared by adding 2.5 mg/kg Esketamine and 8mg ondansetron into normal saline. | Drug: Esketamine<br>* PCIA formula：100ml analgesic solution was prepared by adding 2.5 mg/kg Esketamine and 8mg ondansetron into normal saline. 30min before TACE treatment, the first dose of 2ml was slowly injected intravenously. No obvious adverse reactions were observed for 10min. After that, the intravenous analgesia pump was started. Parameter setting of intravenous analgesia pump: the total volume is 100ml; The duration is 2ml / h; The single dose is 2ml each time; The limit quantity is 10ml / h; The locking time was 10min and the analgesia lasted for 48h. The target value of analgesia in this study was NRS (Numerical Rating Scale)< 4; If NRS ≥ 4, when the effect is still poor after adding drugs by pressing the analgesic pump, the investigators will give the remedial drug(dolantin 50mg im st) according to the patient's condition.<br>* Other names: patient controlled intravenous analgesia;|
| Active Comparator: Sufentanil-PCIA(patient controlled intravenous analgesia)<br>PCIA formula：100ml analgesic solution was prepared by adding 2 μ g/kg sufentanil and 8mg ondansetron into normal saline. | Drug: Sufentanil<br>* PCIA formula：100ml analgesic solution was prepared by adding 2 μ g/kg sufentanil and 8mg ondansetron into normal saline. 30min before TACE treatment, the first dose of 2ml was slowly injected intravenously. No obvious adverse reactions were observed for 10min. After that, the intravenous analgesia pump was started. Parameter setting of intravenous analgesia pump: the total volume is 100ml; The duration is 2ml / h; The single dose is 2ml each time; The limit quantity is 10ml / h; The locking time was 10min and the analgesia lasted for 48h. The target value of analgesia in this study was NRS (Numerical Rating Scale)< 4; If NRS ≥ 4, when the effect is still poor after adding drugs by pressing the analgesic pump, the investigators will give the remedial drug(dolantin 50mg im st) according to the patient's condition.<br>* Other names: patient controlled intravenous analgesia;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximum pain intensity in the first 3 hours of HAIC treatment | Pain intensity is assessed by numerical rating scale pain scores (0-10, 0 represents painless; 10 represents intolerable pain;higher scores mean a worse outcome) | From the beginning of HAIC treatment to 3 hours after HAIC treatment | 
| Pain intensity at 1 hour after HAIC treatment | Pain intensity is assessed by numerical rating scale pain scores (0-10, 0 represents painless; 10 represents intolerable pain;higher scores mean a worse outcome) | From the beginning of HAIC treatment to 1 hour after HAIC treatment | 
| Pain intensity at 2 hours after HAIC treatment | Pain intensity is assessed by numerical rating scale pain scores (0-10, 0 represents painless; 10 represents intolerable pain;higher scores mean a worse outcome) | From 1 hour to 2 hours after HAIC treatment | 
| Pain intensity at 3 hours after HAIC treatment | Pain intensity is assessed by numerical rating scale pain scores (0-10, 0 represents painless; 10 represents intolerable pain;higher scores mean a worse outcome) | From 2 hours to 3 hours after HAIC treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numbers of analgesic pump compressions | When the patients felt pain, the patient controlled analgesia pump can be pressed once | From the beginning of HAIC treatment to 48 hours after HAIC treatment | 
| Analgesic consumption | Analgesic consumption is assessed by the total amount of pain remedy with dolantin when the analgesic effect is poor after pressing analgesic pump for 3 times or more | From the beginning of HAIC treatment to 48 hours after HAIC treatment | 
| Pain intensity at 8 hours after HAIC treatment | Pain intensity is assessed by numerical rating scale pain scores (0-10, 0 represents painless; 10 represents intolerable pain;higher scores mean a worse outcome) | From 7 hours to 8 hours after HAIC treatment | 
| Pain intensity at 16 hours after HAIC treatment | Pain intensity is assessed by numerical rating scale pain scores (0-10, 0 represents painless; 10 represents intolerable pain;higher scores mean a worse outcome) | From 15 hours to 16 hours after HAIC treatment | 
| Pain intensity at 24 hours after HAIC treatment | Pain intensity is assessed by numerical rating scale pain scores (0-10, 0 represents painless; 10 represents intolerable pain;higher scores mean a worse outcome) | From 23 hours to 24 hours after HAIC treatment | 
| Pain intensity at 32 hours after HAIC treatment | Pain intensity is assessed by numerical rating scale pain scores (0-10, 0 represents painless; 10 represents intolerable pain;higher scores mean a worse outcome) | From 31 hours to 32 hours after HAIC treatment | 
| Pain intensity at 40 hours after HAIC treatment | Pain intensity is assessed by numerical rating scale pain scores (0-10, 0 represents painless; 10 represents intolerable pain;higher scores mean a worse outcome) | From 39 hours to 40 hours after HAIC treatment | 
| Pain intensity at 48 hours after HAIC treatment | Pain intensity is assessed by numerical rating scale pain scores (0-10, 0 represents painless; 10 represents intolerable pain;higher scores mean a worse outcome) | From 47 hours to 48 hours after HAIC treatment | 
| Pain intensity on the seventh days after HAIC treatment | Pain intensity is assessed by numerical rating scale pain scores (0-10, 0 represents painless; 10 represents intolerable pain;higher scores mean a worse outcome) | From 7 days to 8 days after HAIC treatment | 
| Pain intensity On the 14th day after HAIC treatment | Pain intensity is assessed by numerical rating scale pain scores (0-10, 0 represents painless; 10 represents intolerable pain;higher scores mean a worse outcome) | From 13 days to 14 days after HAIC treatment | 
| Pain intensity on the 21st after HAIC treatment | Pain intensity is assessed by numerical rating scale pain scores (0-10, 0 represents painless; 10 represents intolerable pain;higher scores mean a worse outcome) | From 20 days to 21 days after HAIC treatment |