J Korean Soc Radiol.  2018 Dec;79(6):323-331. 10.3348/jksr.2018.79.6.323.

The Effectiveness of Ultrasound-Guided Thoracic Paravertebral Block for Percutaneous Radiofrequency Ablation of Hepatic Tumors: A Pilot Study

• Kim H
• Kim Y
• Kim BJ
• Shin SI
• Yim SM
• Lee JH

• KMID: 2427380
• DOI: http://doi.org/10.3348/jksr.2018.79.6.323

Abstract

PURPOSE
The purpose of this study was to evaluate the effectiveness of thoracic paravertebral block (TPVB) for management of pain during and after percutaneous radiofrequency ablation (RFA) of hepatic tumor.
MATERIALS AND METHODS
All patients were divided into non-TPVB (4 patients, 4 sessions of RFA for 4 tumors) and TPVB group (5 patients, 7 sessions of RFAs for 7 tumors). Ultrasound (US)-guided TPVB was performed at T7 level. The 15 mL of 0.375% ropivacaine was injected into right paravertebral space before RFA. If patients complained pain and asked analgesics or experienced pain with verbal numerical rating scale (VNRS) of more than 4, fentanyl 25 µg (up to 100 µg), pethidine 25 mg, and midazolam 0.05 mg/kg (up to 5 mg) were sequentially given intravenously during RFA.
RESULTS
Total intravenous morphine equivalence of analgesics before, during, and after RFA was 129.1 mg and 0.0 mg in non-TPVB and TPVB group, respectively.
CONCLUSION
US-guided TPVB may be an effective and safe anesthetic method for decreasing or eliminating pain during and after RFA for hepatic tumor and helpful in decreasing the usage of opioids.

MeSH Terms

Analgesics
Analgesics, Opioid
Catheter Ablation*
Fentanyl
Humans
Liver Neoplasms
Meperidine
Methods
Midazolam
Morphine
Nerve Block
Pilot Projects*
Ultrasonography
Analgesics
Analgesics, Opioid
Fentanyl
Meperidine
Midazolam
Morphine

Figure

• 

  Fig. 1 The flowchart of premedication and pain management during RFA. If patients asked for analgesics or experienced pain with a verbal numerical rating scale score of more than 4, fentanyl 25 µg (up to 100 µg), pethidine 25 mg, and midazolam 0.05 mg/kg (up to 5 mg) were given intravenously during RFA HCL = hydrochloride, IM = intramuscularly, IV = intravenously, RFA = radiofrequency ablation

• 

  Fig. 2 Ultrasound image of the thoracic paravertebral space before (A) and after (B) administration of the local anesthetic. After administration of the local anesthetic, the pleura (arrows) was displaced anteriorly (arrowhead, needle and tip of needle; aserisk, thoracic paravertebral space). LA = local anesthetic, TP = transverse process

• 

  Fig. 3 Area of sensory loss following thoracic paravertebral block (arrow, needle insertion site of Radiofrequency ablation; arrowheads, upper and lower margin of sensory loss).

• 

  Fig. 4 Location of tumor is marked (arrow) as either right, middle, and left with reference to the vertebral column.

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