Abu Elyazed Mohamed M, Abdullah Mohammad A
Department of Anesthesia and Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt.
J Anaesthesiol Clin Pharmacol. 2018 Apr-Jun;34(2):166-171. doi: 10.4103/joacp.JOACP_39_17.
Percutaneous radiofrequency ablation (PRFA) is a minimally invasive treatment for hepatic tumors. We assessed and compared the efficacy of right thoracic paravertebral block (TPVB) with that of local anesthetic infiltration for the anesthetic management of PRFA of liver tumors.
Sixty patients with hepatic tumors aged 50-80 years were randomly allocated into two groups. Group I received local anesthetic infiltration along the path of the ablation device with sedation. Group II received right TPVB at the level T7 and T9 with sedation. The pain was assessed using visual analog scale (VAS) at 1 min and then every 5 min during PRFA procedure, on admission, and discharge from the post-PRFA observation area. The total dose of rescue analgesia during PRFA procedure, number of patients requiring general anesthesia, patient and radiologist satisfaction were reported.
VAS was significantly lower in group II than group I during and after PRFA procedure ( < 0.05). General anesthesia was administered in 7 patients in group I, whereas no patient required general anesthesia in group II ( < 0.05). Patient and radiologist satisfaction were significantly higher in group II compared to group I ( < 0.05). There were no significant complications in group II compared to group I ( > 0.05).
Right TPVB with sedation is an effective and safe anesthetic technique for the management of PRFA procedure of hepatic tumors. It is more effective than local anesthesia with sedation in relieving pain during PRFA procedure of hepatic tumors.
经皮射频消融术（PRFA）是一种用于肝脏肿瘤的微创治疗方法。我们评估并比较了右胸段椎旁阻滞（TPVB）与局部麻醉药浸润用于肝脏肿瘤PRFA麻醉管理的效果。
将60例年龄在50 - 80岁的肝脏肿瘤患者随机分为两组。第一组在镇静状态下沿消融装置路径进行局部麻醉药浸润。第二组在T7和T9水平进行右胸段椎旁阻滞并给予镇静。在PRFA手术期间、入院时以及从PRFA术后观察区域出院时，使用视觉模拟评分法（VAS）在1分钟时评估疼痛，然后在PRFA手术过程中每5分钟评估一次。报告PRFA手术期间的急救镇痛总剂量、需要全身麻醉的患者数量、患者及放射科医生的满意度。
在PRFA手术期间及术后，第二组的VAS显著低于第一组（<0.05）。第一组有7例患者接受了全身麻醉，而第二组无患者需要全身麻醉（<0.05）。与第一组相比，第二组患者及放射科医生的满意度显著更高（<0.05）。与第一组相比，第二组无显著并发症（>0.05）。
右胸段椎旁阻滞联合镇静是肝脏肿瘤PRFA手术管理的一种有效且安全的麻醉技术。在肝脏肿瘤PRFA手术过程中，它在缓解疼痛方面比局部麻醉联合镇静更有效。
