Use of pethidine for percutaneous liver biopsy - a randomised, placebo-controlled, double blind study.

BACKGROUND: Percutaneous liver biopsy (PLB) is the "gold standard" in the diagnosis of liver diseases. A pilot trial has shown pethidine may reduce anxiety and the need for post-procedural pain relief. The aim of this study was to investigate the role of pre-procedural pethidine. METHODS: A double-blinded, randomized, placebo-controlled trial was conducted to assess the need for pethidine prior to PLB. 98 patients were randomly assigned to receive either 50 mg pethidine i.v. (n = 48), or an equal volume of 0.9% normal saline (n = 50). PLB was performed with ultrasound guidance after adequate local anaesthesia with xylocaine. Patients were asked to self-evaluate pain experienced using a visual analogue score (0-10) immediately and an hour after PLB. Patients were then followed up 24 hours after the procedure to assess their pain score, retrospective pain score and willingness to have a repeat procedure. RESULTS: Pethidine administration resulted in significantly lower pain scores (0.60 ± 0.1 vs 1.2 ± 0.2, p = 0.006) and required less analgesia (0% vs 10%, p = 0.03) immediately after PLB in comparison to the placebo group. There was no significant difference in the pain score and analgesia requirement one hour after the procedure, the pain score at 24 hours after procedure and retrospective pain score. 94% of all patients of either group are willing to under go a repeat liver biopsy (NS). CONCLUSIONS: The administration of pethidine routinely prior to PLB reduces the immediate post procedural pain but has no lasting effect and does not influence the patients' decision making process for future investigations. TRIAL REGISTRATION: ACTRN12614001194651 , 13 November 2014.

Detailed Multi-Dimensional Assessment of Fatigue in Inflammatory Bowel Disease.

BACKGROUND: Fatigue is a symptom commonly reported by patients with inflammatory bowel disease (IBD). Treating any underlying inflammation in active disease improves the health outcomes and decreases fatigue, but fatigue still persists in remission, negatively affecting patients' quality of life and posing a challenge for the treating physician. The aim of this study was to describe the prevalence of fatigue in patients with IBD and investigate possible contributing factors. METHODS: Recruited IBD patients from the Otago region in southern New Zealand were asked to complete demographic, physical activity (IPAQ) and fatigue questionnaires (Brief Fatigue Inventory, Multidimensional Fatigue Inventory). Disease activity and factors contributing to fatigue were assessed through self-reporting and laboratory biomarkers. RESULTS: One hundred and thirteen of the contacted 469 IBD patients participated in the study. Depending on the questionnaire used, the prevalence of fatigue in IBD was high in remission (39.5-44.2%) but significantly higher (p < 0.001) in active disease (80.0-82.9%). Several factors such as age, disease duration, level of physical activity, gender and diet were found to be associated with increased fatigue and were attributed to either mental or physical fatigue categories. Multifactorial Fatigue Inventory provided insights into different types of fatigue, and revealed a significant mental fatigue component in both active and remission disease patients. Iron deficiency was not associated with fatigue levels. CONCLUSIONS: Fatigue in IBD is multi-faceted and highly prevalent in both active and remission IBD. Further investigations, addressing the complexity of the symptom and its reporting are needed.