Harvard Medical School, Massachusetts General Hospital, Boston, USA.
Division of Vascular and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
Sci Rep. 2023 Aug 24;13(1):13854. doi: 10.1038/s41598-023-36607-1.
Although ablations are performed with conscious sedation or general anesthesia, microwave ablations can be painful post procedure. Newer analgesic modalities, including regional blocks, have promoted the proliferation of less invasive anesthesia care for ablative procedures. This study evaluates whether bilateral paravertebral blocks reduce the need for additional analgesics in comparison to unilateral blocks in microwave ablations. In this retrospective study, individuals undergoing microwave ablation who underwent unilateral versus bilateral nerve blocks at a single institution from 2017 to 2019 were compared. Categorical variables were analyzed using Pearson's chi-squared tests. Comparisons of means were completed using multiple T-tests corrected using the Holm-Sidak method with α = 0.05. Regression modeling was used to identify factors related to increased MME (milligram morphine equivalent) usage and post-procedure admission rates. A total of 106 patients undergoing 112 liver MWA procedures were included in this analysis, with patients receiving either a bilateral or unilateral block. Pre-procedural characteristics demonstrated no significant differences in age or gender. Bilateral blocks were associated with decreased usage of gabapentin (14% vs. 0%, p = 0.01) and a lower rate of post-procedure admissions (OR 0.23, p = 0.003). Therefore, when using paravertebral blocks, bilateral blocks are superior to unilateral blocks, as demonstrated by decreased rates of hospital admission and reduced use of systemic neuropathic pain medication. Additionally, reducing post-procedural MME may reduce the rate of admission to the hospital.
尽管消融术是在清醒镇静或全身麻醉下进行的，但微波消融术后可能会感到疼痛。较新的镇痛方式，包括区域阻滞，促进了对消融术的侵入性较小的麻醉护理的普及。本研究评估了与单侧阻滞相比，双侧椎旁阻滞是否能减少微波消融术后对额外镇痛药物的需求。在这项回顾性研究中，比较了在单个机构接受单侧或双侧神经阻滞的 2017 年至 2019 年间接受微波消融的个体。使用 Pearson 卡方检验分析分类变量。使用校正后的多 T 检验比较均值，使用 Holm-Sidak 方法校正，α=0.05。回归模型用于确定与增加 MME（吗啡毫克当量）使用量和术后住院率相关的因素。共纳入 106 例接受 112 例肝脏 MWA 手术的患者，这些患者接受了单侧或双侧阻滞。术前特征显示年龄和性别无显著差异。双侧阻滞与加巴喷丁的使用率降低（14%比 0%，p=0.01）和术后住院率降低（OR 0.23，p=0.003）相关。因此，在使用椎旁阻滞时，双侧阻滞优于单侧阻滞，表现在降低住院率和减少全身神经痛药物的使用。此外，减少术后 MME 可能会降低住院率。
