Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, People's Republic of China.
Br J Radiol. 2011 Sep;84(1005):785-9. doi: 10.1259/bjr/28983063. Epub 2010 Nov 16.
Percutaneous radiofrequency ablation (PRFA) of liver tumours performed under local anaesthesia and intravenous sedation can cause severe pain to patients. This prospective study evaluated the efficacy of a right thoracic paravertebral block (TPVB) for anaesthesia and analgesia during PRFA of liver tumours.
20 patients, aged 44-74 years, with liver malignancies received a multiple injection TPVB at the T6-10 levels 30 min before the PRFA. An intravenous infusion of propofol (3-5 mg kg(-1) h(-1)) was administered to patients who requested to be sedated and intravenous fentanyl (25 µg bolus) was administered as rescue analgesia. Pain during the TPVB and PRFA was assessed using a numerical rating scale (NRS; 0, no pain; 10, worst imaginable pain). Patients were also assessed for residual pain and analgesic consumption during the 24 h after the intervention.
The TPVB was well tolerated and produced ipsilateral sensory anaesthesia with satisfactory spread (median (range); 8 (6-11) dermatomes). The PRFA procedure caused mild pain (mean (standard deviation, SD); NRS 1.4 (1.9)) during the insertion of the ablation needle and the peak pain intensity during the therapeutic burn was moderate (mean (SD); NRS 5.0 (3.3)) in severity. During the 24 h after the PRFA, patients reported minimal pain and consumed very few analgesics. The mean (SD) satisfaction score (0, totally dissatisfied; 10, very satisfied) of the patients was 8.9 (1.1) and that of the radiologists was 8.8 (1.4).
A right TPVB is safe and effective for anaesthesia and analgesia during PRFA of malignant liver tumours.
在局部麻醉和静脉镇静下进行的肝脏肿瘤经皮射频消融术（PRFA）可能会引起患者剧烈疼痛。本前瞻性研究评估了胸椎旁阻滞（TPVB）在 PRFA 治疗肝脏肿瘤时用于麻醉和镇痛的效果。
20 名年龄在 44-74 岁之间的肝脏恶性肿瘤患者在 PRFA 前 30 分钟接受 T6-10 水平的多针 TPVB。要求镇静的患者给予异丙酚静脉输注（3-5mg/kg/h），并给予静脉芬太尼（25µg 推注）作为解救镇痛。TPVB 和 PRFA 过程中的疼痛采用数字评分量表（NRS；0 为无痛；10 为可想象到的最剧烈疼痛）进行评估。还评估了干预后 24 小时内的残留疼痛和镇痛药物消耗情况。
TPVB 耐受良好，产生了同侧感觉麻醉，感觉阻滞范围满意（中位数（范围）；8（6-11）个皮节）。PRFA 过程中，消融针插入时疼痛轻微（NRS 1.4（1.9）），治疗性灼烧时疼痛峰值为中度（NRS 5.0（3.3））。PRFA 后 24 小时内，患者报告疼痛轻微，镇痛药消耗量很少。患者的平均（标准差）满意度评分（0 为非常不满意；10 为非常满意）为 8.9（1.1），放射科医生的满意度评分为 8.8（1.4）。
右侧 TPVB 用于恶性肝脏肿瘤 PRFA 的麻醉和镇痛是安全有效的。
