Piccioni Federico, Fumagalli Luca, Garbagnati Francesco, Di Tolla Giuseppe, Mazzaferro Vincenzo, Langer Martin
Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy.
Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy.
J Clin Anesth. 2014 Jun;26(4):271-5. doi: 10.1016/j.jclinane.2013.11.019. Epub 2014 May 20.
To present our preliminary experience using a thoracic paravertebral block (TPVB) as the sole anesthetic in percutaneous hepatic radiofrequency ablation (RFA).
Retrospective case series of 12 ASA physical status 1, 2, and 3 patients of average risk scheduled for RFA.
University medical center.
The first 12 procedures performed using TPVB were analyzed to evaluate the efficacy and safety of this anesthetic technique. Data collected included patients' characteristics, procedure, pain referred during paravertebral punctures, and RFA (verbal numerical scale; VNS). Anesthesia and medical records also were reviewed for any major complications that occurred during or after the RFA.
Ten of the 12 patients presented for hepatocellular carcinoma; the other two patients had melanoma metastasis. Nine patients were ASA physical status 1 or 2; the other three patients were ASA physical status 3. Nine had liver cirrhosis. All patients had normal coagulation profiles. The TPVBs were performed in a median time of 6.5 (4-15) minutes. Onset of sensory loss to pinprick test occurred approximately 15 to 20 minutes after the injections. No evidence of bilateral blockade was seen in any patient. In most cases, the extent of anesthesia ranged from T6 to T11 or T12. In one patient (no. 2), the stimulating needle elicited no sensory or motor response at the T7 level; the local anesthetic was then injected one cm beyond the transverse process. All patients were very pleased with their anesthetic care; all were discharged from the hospital with no procedure-related complications.
The use of thoracic paravertebral block as the sole anesthetic for RFA of liver produced satisfactory unilateral anesthesia and minor adverse events.
介绍我们将胸段椎旁阻滞（TPVB）作为经皮肝射频消融术（RFA）唯一麻醉方法的初步经验。
对12例美国麻醉医师协会（ASA）身体状况为1、2和3级的平均风险患者进行RFA的回顾性病例系列研究。
大学医学中心。
分析最初12例使用TPVB的手术，以评估这种麻醉技术的有效性和安全性。收集的数据包括患者特征、手术过程、椎旁穿刺时的牵涉痛以及RFA（语言数字评分法；VNS）。还查阅了麻醉和医疗记录，以查找RFA期间或之后发生的任何重大并发症。
12例患者中有10例为肝细胞癌；另外2例患者有黑色素瘤转移。9例患者ASA身体状况为1或2级；另外3例患者ASA身体状况为3级。9例有肝硬化。所有患者凝血指标均正常。TPVB的中位操作时间为6.5（4 - 15）分钟。针刺试验感觉丧失在注射后约15至20分钟出现。所有患者均未出现双侧阻滞的证据。在大多数情况下，麻醉范围为T6至T11或T12。1例患者（第2例），刺激针在T7水平未引出感觉或运动反应；然后在横突外1 cm处注射局部麻醉药。所有患者对其麻醉护理都非常满意；所有患者均出院，无手术相关并发症。
将胸段椎旁阻滞作为肝脏RFA的唯一麻醉方法可产生满意的单侧麻醉效果且不良事件较少。
