Abdominal Radiology

, Volume 44, Issue 1, pp 286–291 | Cite as

Pain in percutaneous liver core-needle biopsy: a randomized trial comparing the intercostal and subcostal approaches

  • Masoud Pezeshki Rad
  • Bita Abbasi
  • Negar Morovatdar
  • Masoomeh Sadeghi
  • Khaled HashemiEmail author



Effective pain control during and after percutaneous core needle liver biopsy is important with regard to ethical considerations and patient comfort. In this randomized double-blind study, we compared post-biopsy pain in the patients undergoing liver core-needle biopsy using either subcostal or intercostal approaches.


All patients referred for ultrasound-guided CNLB between July 2017 and January 2018 to our interventional radiology department were randomized into two groups. Biopsy was performed through intercostal approach in the first group and through subcostal approach in the second group. The intensity of pain 0, 2, and 4 h after the procedure was compared in two groups using a 100-mm visual analogue scale. All biopsies were performed without procedural IV sedation. If patients’ discomfort  demanded administration of IV analgesics during or after the procedure, then the patients were excluded from the study.


In patients without routine procedural IV sedation, there was no significant difference in the pain level between the intercostal and subcostal groups immediately after the procedure (p = 0.055), but we found a significant difference in the pain level between the two groups 2 (7.5 mm, p = 0.001) and 4 (2 mm, p = 0.001) h after the procedure.


The minimum amount of change in the VAS score that is considered clinically important is 13 mm on a 100-mm scale. Pain differences at 2 and 4 h in the two groups in this study were statistically but not clinically significant. Therefore, the authors suggest the use of subcostal route for ultrasound-guided liver biopsy whenever possible, but the results do not warrant the routine use of post-procedure analgesics in whom biopsy is performed via intercostal route.


Image-guided biopsy Pain Ultrasonography 



This research was financially supported by the Chancellor for Research of Mashhad University of Medical Sciences, Mashhad, Iran.

Compliance with ethical standards


This randomized, parallel, double-blind study was approved by the Chancellor for Research of Mashhad University of Medical Sciences, Mashhad, Iran. The registration code of IRCT20180106038249N1 was assigned to this trial.

Conflict of interest

The authors declare no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Masoud Pezeshki Rad
    • 1
  • Bita Abbasi
    • 1
  • Negar Morovatdar
    • 2
  • Masoomeh Sadeghi
    • 1
  • Khaled Hashemi
    • 1
    Email author
  1. 1.Department of Radiology, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
  2. 2.Clinical Research UnitMashhad University of Medical SciencesMashhadIran

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