Department of Radiology, San Paolo Hospital, Via A. Di Rudinì 8, 20142, Milan, Italy.
Department of Radiology, Università Degli Studi Dell'Insubria, Viale L. Borri 57, 21100, Varese, Italy.
Med Oncol. 2020 Mar 12;37(4):22. doi: 10.1007/s12032-020-01347-z.
Radiofrequency ablation is a minimally invasive procedure alternative to surgery to treat benign thyroid nodules causing compressive symptoms. Tolerability of this procedure, aimed at treatment of benign conditions, is fundamental. In this study, we evaluated if local anesthesia should be enough to reduce both hospital costs and sedation-related risks for the patient, avoiding deep sedation and presence of the anesthesiologist. From July 2017 to August 2018, 14 consecutive patients (mean age 60.1 years) were treated and divided in two groups: Group A (7 patients) underwent systemic sedoanalgesia (intravenous remifentanil/fentanyl ± intravenous midazolam ± intravenous acetaminophen/nonsteroidal anti-inflammatory drugs) + subcutaneous anesthesia (lidocaine), with anesthesiologist. Group B (7 patients) underwent mild systemic sedoanalgesia (oral solution morphine sulfate + intravenous midazolam + intravenous acetaminophen) + both subcutaneous and subcapsular anesthesia (mepivacaine + bupivacaine), without anesthesiologist. Tolerability, sedation grade (Ramsay scale), total opioid dose, complications, and results at 12 months were analyzed and compared. Mean tolerability was 9.4 in group A and 8.9 in group B (p: 0.786). Mean sedation grade was 3.86 in group A and 2.71 in group B (p: 0.016). Mean total opioid dose was 70.9 mg in group A and 10 mg in group B (p:0.00015). No complications were observed. At 12 months, mean volume reduction was 56.1% in the group A and 60% in the group B. In thyroid radiofrequency ablation, subcapsular anesthesia can decrease both total opioid dose and level of patient's sedation without significant differences in tolerability, allowing to perform ablation without the anesthesiologist.
射频消融术是一种微创替代手术的方法，用于治疗导致压迫症状的良性甲状腺结节。这种旨在治疗良性疾病的方法的耐受性至关重要。在这项研究中，我们评估了局部麻醉是否足以降低医院成本和患者镇静相关风险，避免深度镇静和麻醉师的存在。从 2017 年 7 月至 2018 年 8 月，连续 14 例患者（平均年龄 60.1 岁）接受了治疗，并分为两组：A 组（7 例）接受全身镇静镇痛（静脉注射瑞芬太尼/芬太尼 ± 静脉注射咪达唑仑 ± 静脉注射对乙酰氨基酚/非甾体抗炎药） + 皮下麻醉（利多卡因），并配备麻醉师。B 组（7 例）接受轻度全身镇静镇痛（硫酸吗啡口服液 + 静脉注射咪达唑仑 + 静脉注射对乙酰氨基酚） + 皮下和包膜下麻醉（甲哌卡因 + 布比卡因），无麻醉师。分析和比较了两组患者的耐受性、镇静分级（Ramsay 量表）、总阿片类药物剂量、并发症和 12 个月的结果。A 组的平均耐受性为 9.4，B 组为 8.9（p：0.786）。A 组的平均镇静分级为 3.86，B 组为 2.71（p：0.016）。A 组的总阿片类药物剂量为 70.9mg，B 组为 10mg（p：0.00015）。未观察到并发症。12 个月时，A 组的平均体积减少率为 56.1%，B 组为 60%。在甲状腺射频消融术中，包膜下麻醉可以减少总阿片类药物剂量和患者镇静水平，而不影响耐受性，允许在没有麻醉师的情况下进行消融。
