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Wang L, Lu M, Wang S, Wu X, Tan B, Xu J, Zou J, He Y. Combined multiple regional anesthesia for microwave ablation of liver Tumors: Initial experience. Eur J Radiol 2023; 169:111147. [PMID: 37913695 DOI: 10.1016/j.ejrad.2023.111147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE This study aims to assess the feasibility and safety of combined multiple regional anesthesia (CMRA) as a potential strategy to decrease pain and reliance on intravenous analgesics during and after ultrasound-guided microwave ablation (US-guided-MWA) of liver tumors. METHODS A cohort of 75 patients with a total of 99 liver tumors who underwent US-guided-MWA of liver tumors were enrolled. These patients were randomly allocated into three groups: A, B, and C. Prior to the ablation procedure, Group A patients received a combination of hepatic hilar block (HHB), Transversus abdominis plane block (TAPB), and local anesthesia (LA). Patients in Group B were administered HHB in conjunction with LA, while those in Group C received TAPB and LA. Evaluative parameters included the Numerical Rating Scale (NRS) scores, consumption of morphine, incidence of complications, and factors influencing perioperative pain. RESULTS All patients successfully underwent US-guided-MWA. The peak NRS scores for pain during ablation across the three groups were 2.36 ± 1.19, 3.28 ± 1.59, and 4.24 ± 1.42 respectively (P < 0.01), while the count of patients requiring morphine were 4/25, 8/25, and 13/25 respectively (P < 0.01). Postoperative NRS scores for the three groups at 4, 8, 12, 24, and 36-hour intervals demonstrated a pattern of initial increase followed by a decrease, with the order at each interval being: Group A < Group C < Group B. Factors associated with increased pain included larger tumor size, greater number of tumors, and longer procedure and ablation time (P < 0.05). No major complications were recorded across the three groups. CONCLUSION CMRA offers an effective and safe modality to manage pain during and after US-guided-MWA of liver tumors.
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Affiliation(s)
- Lu Wang
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Man Lu
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Shishi Wang
- From the School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075 China.
| | - Xiaobo Wu
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Bo Tan
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Jinshun Xu
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Jie Zou
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Yi He
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
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Wicks JS, Dale BS, Ruffolo L, Pack LJ, Dunne R, Laryea MA, Hernandez-Alejandro R, Sharma AK. Comparable and Complimentary Modalities for Treatment of Small-Sized HCC: Surgical Resection, Radiofrequency Ablation, and Microwave Ablation. J Clin Med 2023; 12:5006. [PMID: 37568408 PMCID: PMC10419984 DOI: 10.3390/jcm12155006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Over the past decade, there has been continual improvement in both ablative and surgical technologies for the treatment of hepatocellular carcinoma (HCC). The efficacy of ablative therapy compared to surgical resection for HCC has not been thoroughly evaluated using multiple large-scale randomized controlled trials. By international consensus, if a patient is eligible, surgery is the primary curative treatment option, as it is believed to confer superior oncologic control. OBJECTIVE to determine the efficacies of percutaneous ablative therapies and surgical resection (SR) in the treatment of HCC. Data sources, study appraisal, and synthesis methods: A meta-analysis using 5 online databases dating back to 1989 with more than 31,000 patients analyzing patient and tumor characteristics, median follow-up, overall survival, and complication rate was performed. RESULTS Ablative therapies are suitable alternatives to surgical resection in terms of survival and complication rates for comparable patient populations. For the entire length of the study from 1989-2019, radiofrequency ablation (RFA) produced the highest 5-year survival rates (59.6%), followed by microwave ablation (MWA) (50.7%) and surgical resection (SR) (49.9%). In the most recent era from 2006 to 2019, surgical resection has produced the highest 5-year survival rate of 72.8%, followed by RFA at 61.7% and MWA at 50.6%. Conclusions and key findings: Depending on the disease state and comorbidities of the patient, one modality may offer superior overall survival rates over the other available techniques. Interventional ablative methods and surgical resection should be used in conjunction for the successful treatment of small-sized HCC.
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Affiliation(s)
- Jeffrey S. Wicks
- Department of Biology, University of Rochester, Rochester, NY 14642, USA;
| | - Benjamin S. Dale
- Department of Surgery, University of Rochester, Rochester, NY 14642, USA; (B.S.D.); (L.R.)
| | - Luis Ruffolo
- Department of Surgery, University of Rochester, Rochester, NY 14642, USA; (B.S.D.); (L.R.)
| | - Ludia J. Pack
- Department of Genetics, University of Rochester, Rochester, NY 14642, USA;
| | - Richard Dunne
- Division of Hematology/Oncology, Department of Medicine, University of Rochester, Rochester, NY 14642, USA;
| | - Marie A. Laryea
- Division of Gastroenterology/Hepatology, Department of Medicine, University of Rochester, Rochester, NY 14642, USA;
| | | | - Ashwani Kumar Sharma
- Division of Interventional Radiology, Department of Imaging Sciences, University of Rochester, Rochester, NY 14642, USA
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He KS, Fernando R, Cabrera T, Valenti D, Algharras A, Martínez N, Liu DM, Noel G, Muchantef K, Bessissow A, Boucher LM. Hepatic Hilar Nerve Block for Hepatic Interventions: Anatomy, Technique, and Initial Clinical Experience in Thermal Ablation of Liver Tumors. Radiology 2021; 301:223-228. [PMID: 34254852 DOI: 10.1148/radiol.2021203410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Image-guided procedures for treatment of liver diseases can be painful and require heavy sedation of the patient. Local-regional nerve blocks improve pain control and reduce oversedation risks, but there are no documented liver-specific nerve blocks. Purpose To develop a safe and technically simple liver-specific nerve block. Materials and Methods Between March 2017 and October 2019, three cadavers were dissected to evaluate the hepatic hilar anatomy. The hepatic hilar nerves were targeted with transhepatic placement of a needle adjacent to the main portal vein, under US guidance, and evaluated with use of an injection of methylene blue. A hepatic nerve block, using similar technique and 0.25% bupivacaine, was offered to patients undergoing liver tumoral ablation. In a prospective pilot study, 12 patients who received the nerve block were compared with a control group regarding complications, safety, pain scores, and intraoperative opioid requirement. Student t tests were used to compare the groups' characteristics, and Mann-Whitney U tests were used for the measured outcomes. Results Cadaver results confirmed that the hepatic nerves coursing in the hepatic hilum can be targeted with US for injection of anesthetic agents, with adequate spread of injected methylene blue around the nerves in the hepatic hilar perivascular space. The 12 participants (mean age ± standard deviation, 66 years ± 13; eight men) who received a hepatic hilar block before liver thermal ablations demonstrated reduced pain compared with a control group of 12 participants (mean age, 63 years ± 15; eight men) who received only intravenous sedation. Participants who received the nerve block had a lower mean visual analog scale score for pain than the control group (3.9 ± 2.4 vs 7.0 ± 2.8, respectively; P = .01) and decreased need for intraprocedural fentanyl (mean dose, 152 μg ± 78.0 vs 235.4 μg ± 58.2, respectively; P = .01). No major complications occurred in the hepatic hilar nerve block group. Conclusion A dedicated hepatic hilar nerve block with 0.25% bupivacaine can be safely performed to provide anesthesia during liver tumoral ablation. © RSNA, 2021.
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Affiliation(s)
- Kevin S He
- From the Departments of Diagnostic Radiology (K.S.H., T.C., D.V., A.A., K.M., A.B., L.M.B.) and Anatomical Sciences (G.N.), McGill University Health Centre, 1001 Blvd Décarie, Montreal, QC, Canada H4A 3J1; Department of Radiology, Auckland City Hospital, Auckland, New Zealand (R.F.); Department of Radiology, University of Chile Clinical Hospital, Independencia, Chile (N.M.); and Department of Radiology, University of British Columbia, Vancouver, Canada (D.M.L.)
| | - Rukshan Fernando
- From the Departments of Diagnostic Radiology (K.S.H., T.C., D.V., A.A., K.M., A.B., L.M.B.) and Anatomical Sciences (G.N.), McGill University Health Centre, 1001 Blvd Décarie, Montreal, QC, Canada H4A 3J1; Department of Radiology, Auckland City Hospital, Auckland, New Zealand (R.F.); Department of Radiology, University of Chile Clinical Hospital, Independencia, Chile (N.M.); and Department of Radiology, University of British Columbia, Vancouver, Canada (D.M.L.)
| | - Tatiana Cabrera
- From the Departments of Diagnostic Radiology (K.S.H., T.C., D.V., A.A., K.M., A.B., L.M.B.) and Anatomical Sciences (G.N.), McGill University Health Centre, 1001 Blvd Décarie, Montreal, QC, Canada H4A 3J1; Department of Radiology, Auckland City Hospital, Auckland, New Zealand (R.F.); Department of Radiology, University of Chile Clinical Hospital, Independencia, Chile (N.M.); and Department of Radiology, University of British Columbia, Vancouver, Canada (D.M.L.)
| | - David Valenti
- From the Departments of Diagnostic Radiology (K.S.H., T.C., D.V., A.A., K.M., A.B., L.M.B.) and Anatomical Sciences (G.N.), McGill University Health Centre, 1001 Blvd Décarie, Montreal, QC, Canada H4A 3J1; Department of Radiology, Auckland City Hospital, Auckland, New Zealand (R.F.); Department of Radiology, University of Chile Clinical Hospital, Independencia, Chile (N.M.); and Department of Radiology, University of British Columbia, Vancouver, Canada (D.M.L.)
| | - Abdulaziz Algharras
- From the Departments of Diagnostic Radiology (K.S.H., T.C., D.V., A.A., K.M., A.B., L.M.B.) and Anatomical Sciences (G.N.), McGill University Health Centre, 1001 Blvd Décarie, Montreal, QC, Canada H4A 3J1; Department of Radiology, Auckland City Hospital, Auckland, New Zealand (R.F.); Department of Radiology, University of Chile Clinical Hospital, Independencia, Chile (N.M.); and Department of Radiology, University of British Columbia, Vancouver, Canada (D.M.L.)
| | - Nicolás Martínez
- From the Departments of Diagnostic Radiology (K.S.H., T.C., D.V., A.A., K.M., A.B., L.M.B.) and Anatomical Sciences (G.N.), McGill University Health Centre, 1001 Blvd Décarie, Montreal, QC, Canada H4A 3J1; Department of Radiology, Auckland City Hospital, Auckland, New Zealand (R.F.); Department of Radiology, University of Chile Clinical Hospital, Independencia, Chile (N.M.); and Department of Radiology, University of British Columbia, Vancouver, Canada (D.M.L.)
| | - David M Liu
- From the Departments of Diagnostic Radiology (K.S.H., T.C., D.V., A.A., K.M., A.B., L.M.B.) and Anatomical Sciences (G.N.), McGill University Health Centre, 1001 Blvd Décarie, Montreal, QC, Canada H4A 3J1; Department of Radiology, Auckland City Hospital, Auckland, New Zealand (R.F.); Department of Radiology, University of Chile Clinical Hospital, Independencia, Chile (N.M.); and Department of Radiology, University of British Columbia, Vancouver, Canada (D.M.L.)
| | - Geoffroy Noel
- From the Departments of Diagnostic Radiology (K.S.H., T.C., D.V., A.A., K.M., A.B., L.M.B.) and Anatomical Sciences (G.N.), McGill University Health Centre, 1001 Blvd Décarie, Montreal, QC, Canada H4A 3J1; Department of Radiology, Auckland City Hospital, Auckland, New Zealand (R.F.); Department of Radiology, University of Chile Clinical Hospital, Independencia, Chile (N.M.); and Department of Radiology, University of British Columbia, Vancouver, Canada (D.M.L.)
| | - Karl Muchantef
- From the Departments of Diagnostic Radiology (K.S.H., T.C., D.V., A.A., K.M., A.B., L.M.B.) and Anatomical Sciences (G.N.), McGill University Health Centre, 1001 Blvd Décarie, Montreal, QC, Canada H4A 3J1; Department of Radiology, Auckland City Hospital, Auckland, New Zealand (R.F.); Department of Radiology, University of Chile Clinical Hospital, Independencia, Chile (N.M.); and Department of Radiology, University of British Columbia, Vancouver, Canada (D.M.L.)
| | - Ali Bessissow
- From the Departments of Diagnostic Radiology (K.S.H., T.C., D.V., A.A., K.M., A.B., L.M.B.) and Anatomical Sciences (G.N.), McGill University Health Centre, 1001 Blvd Décarie, Montreal, QC, Canada H4A 3J1; Department of Radiology, Auckland City Hospital, Auckland, New Zealand (R.F.); Department of Radiology, University of Chile Clinical Hospital, Independencia, Chile (N.M.); and Department of Radiology, University of British Columbia, Vancouver, Canada (D.M.L.)
| | - Louis-Martin Boucher
- From the Departments of Diagnostic Radiology (K.S.H., T.C., D.V., A.A., K.M., A.B., L.M.B.) and Anatomical Sciences (G.N.), McGill University Health Centre, 1001 Blvd Décarie, Montreal, QC, Canada H4A 3J1; Department of Radiology, Auckland City Hospital, Auckland, New Zealand (R.F.); Department of Radiology, University of Chile Clinical Hospital, Independencia, Chile (N.M.); and Department of Radiology, University of British Columbia, Vancouver, Canada (D.M.L.)
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Semenas E, Lönnemark M, Dahlman P, Hultström M, Eriksson M. Analgesic effects of dexmedetomidine and remifentanil on periprocedural pain during percutaneous ablation of renal carcinoma. Ups J Med Sci 2020; 125:52-57. [PMID: 32067572 PMCID: PMC7054959 DOI: 10.1080/03009734.2020.1720047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Percutaneous ablation of renal carcinoma is frequently a favourable treatment alternative, especially in elderly patients suffering from co-morbidities. Also, it is less resource-demanding than conventional surgery of renal carcinoma, and one may, therefore, assume that the incidence of this procedure may increase. Analgesia is necessary during this intervention. The aim of this study was to explore the possibility of analgosedation and its relation to patient comfort and safety during percutaneous ablation of renal carcinoma.Methods: Forty-six patients, sedated with dexmedetomidine and remifentanil, supplemented with infiltration anaesthesia (lidocaine 1%), underwent percutaneous (radiofrequency or microwave) ablation of renal carcinoma in this prospective study.Results: The patients expected pain intensity around the numerical rating score (NRS) 4.5 (interquartile range [IQR] 3.5-5.5), which was slightly lower than pain experienced during the procedure NRS 5 (IQR 2-7; p = 0.49). Eight percent of the patients needed supplementary morphine during the ablation procedure. Sedation score did not differ during ablation, at arrival to or discharge from the recovery ward. Median periprocedural treatment time was 12 minutes (IQR 12-16). Treatment time did not correlate with experienced pain (R2=0.000074, p = 0.96). The median length of stay in the recovery room was 120 minutes (IQR 84-154). There were seven serious adverse events.Conclusions: This proof-of-concept study has shown that analgosedation during percutaneous ablation of renal carcinoma can be performed with a generally tolerable degree of patient satisfaction. However, pain occurs and should be managed adequately. Patient safety must be a major concern for the anaesthetic care.
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Affiliation(s)
- Egidijus Semenas
- Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Lönnemark
- Section of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Pär Dahlman
- Section of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Michael Hultström
- Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Section for Integrative Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Mats Eriksson
- Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- CONTACT Mats Eriksson Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University Hospital, 751 85 Uppsala, Sweden
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Sato K, Taniki N, Kanazawa R, Shimizu M, Ishii S, Ohama H, Takawa M, Nagamatsu H, Imai Y, Shiina S. Efficacy and Safety of Deep Sedation in Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma. Adv Ther 2019; 36:344-354. [PMID: 30607546 DOI: 10.1007/s12325-018-0865-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) has been accepted as safe and effective for treating early-stage hepatocellular carcinoma (HCC). However, it often causes severe pain. Therefore, in this study, we performed RFA under deep sedation and investigated its efficacy and safety. METHODS We conducted a retrospective study including 511 HCC patients who received approximately 886 RFA treatments between December 2014 and November 2016 at our institution. Respiratory depression was defined as oxygen saturation of below 90%; and severe body movement was defined as movement caused by pain, which was managed by lowering the power of the generator. Factors associated with respiratory depression and severe body movement were examined via univariate and multivariate regression analyses. RESULTS Respiratory depression occurred in 15.3% of the patients and severe body movement in 26.5% of the patients. In the multivariate analysis, BMI (≥ 25 kg/m2, odds ratio [OR] = 1.75, P = 0.035) and longer ablation (≥ 10 min, OR = 2.59, P = 0.002) were significant respiratory depression-related factors. Male sex (OR = 2.02, P = 0.005), Child-Pugh class A (odds ratio = 1.96, P = 0.018), and longer ablation (≥ 10 min, OR = 3.03, P < 0.001) were significant factors related to severe body movement. CONCLUSION Deep sedation for RFA can be performed safely and effectively. Higher BMI and longer ablation were risk factors for respiratory depression and male sex, Child-Pugh class A, and longer ablation were independent predictors of severe body movement during RFA under deep sedation.
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Affiliation(s)
- Koki Sato
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Nobuhito Taniki
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryo Kanazawa
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Motonori Shimizu
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shigeto Ishii
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hideko Ohama
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Masashi Takawa
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroaki Nagamatsu
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuharu Imai
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
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