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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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Jain S, Blume H, Rodriguez L, Petre E, Moussa A, Zhao K, Sotirchos V, Raj N, Reidy D, Ziv E, Alexander E. Hepatic Hilar Block as an Adjunct to Transarterial Embolization of Neuroendocrine Tumors: A Retrospective Review of Safety and Efficacy. Cancers (Basel) 2023; 15:5202. [PMID: 37958376 PMCID: PMC10647661 DOI: 10.3390/cancers15215202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/09/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
PURPOSE This study investigates whether hepatic hilar nerve blocks (HHNB) provide safe, effective analgesia in patients with neuroendocrine tumors (NET) treated with transarterial embolization (TAE). METHODS The retrospective study included all NETs treated with TAE or TAE + HHNB from 1/2020 to 8/2022. Eighty-five patients (45 men), mean age 62 years, were treated in 165 sessions (TAE, n = 153; TAE + HHNB, n = 12). For HHNBs, ≤10 mL bupivacaine HCl 0.25% ± 2 mg methylprednisolone were injected under ultrasound guidance. The aims were to assess safety of HHNB and reduction in pain. Groups were compared with Pearson's chi-squared and Wilcoxon rank sum tests. Logistic regression assessed independent risk factors for pain. RESULTS No immediate complications from HHNBs were reported. No difference in incidence of major complications between TAE and TAE + HHNB one month post-embolization was observed (7.19% vs. 8.33%, p = 0.895). No differences in mean length of hospital stay after treatment were observed (TAE 2.2 days [95%CI: 1.74-2.56] vs. TAE + HHNB 2.8 days [95%CI: 1.43-4.26]; p = 0.174). Post-procedure pain was reported in 88.2% of TAE and 75.0% of TAE + HHNB patients (p = 0.185). HHNB recipients were more likely to use analgesic patches (25.0% vs. 5.88%; p = 0.014). No other differences in analgesic use were observed. CONCLUSIONS HHNBs can safely be performed in patients with NETs. No difference in hospital stays or analgesic drug use was observed. Managing pain after TAE is an important goal; further study is warranted.
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Affiliation(s)
- Samagra Jain
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
- Baylor College of Medicine, School of Medicine, One Baylor Plaza, Houston, TX 77004, USA
| | - Harrison Blume
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
- Albert Einstein College of Medicine, School of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, USA
| | - Lee Rodriguez
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
| | - Elena Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
| | - Amgad Moussa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
| | - Ken Zhao
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
| | - Vlasios Sotirchos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
| | - Nitya Raj
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (N.R.); (D.R.)
| | - Diane Reidy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (N.R.); (D.R.)
| | - Etay Ziv
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
| | - Erica Alexander
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; (S.J.); (H.B.); (L.R.); (E.P.); (A.M.); (K.Z.); (V.S.); (E.Z.)
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Tan E, Wang MQW, Leong S, Chou H, Too CW. Neurological pain relief interventional radiology procedures. Clin Radiol 2023; 78:254-264. [PMID: 35773096 DOI: 10.1016/j.crad.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/29/2022] [Indexed: 11/24/2022]
Abstract
Neurological interventions have taken on a significant role in interventional radiology (IR) practice. Indications fall under three main categories: (1) intraprocedural pain management, (2) cancer pain palliation, and (3) chronic non-cancer pain control. Short-term regional anaesthesia can be achieved with local anaesthetics, while longer-term pain control can be attained with radiofrequency neuromodulation (pulsed or otherwise) or thermal/chemical neurolysis. This review article summarises the therapeutic options, applications, and techniques of commonly used peripheral nerve and plexus interventions in IR.
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Affiliation(s)
- E Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - M Q W Wang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - S Leong
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - H Chou
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - C W Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
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Kuang D, Chao R, Youm J, Hugdal S, Miller B, Sung J. Regional Anesthesia as an Alternative to Moderate Sedation for Perioperative Pain Control for Percutaneous Gastrostomy Tube Placement. J Vasc Interv Radiol 2022; 33:1361-1365.e1. [PMID: 36511307 DOI: 10.1016/j.jvir.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/23/2022] [Accepted: 05/29/2022] [Indexed: 12/15/2022] Open
Abstract
Percutaneous gastrostomy tube placement is typically performed under moderate sedation. However, some patients are not ideal candidates for moderate sedation because of respiratory compromise, difficult airways, or other factors. The purpose of this study was to evaluate regional anesthesia as an alternative to moderate sedation. A retrospective review of patients who underwent percutaneous gastrostomy tube placement between March 2014 and September 2020 was performed. Data on patient demographics, anesthesia type, pain scores, and opiate usage were collected. A total of 189 patients were included in the study; 35 (18.5%) received regional anesthesia and 154 received moderate sedation. Patients in the regional anesthesia group tolerated the procedure well, with lower mean immediate postprocedural and maximal pain scores of 0.7 vs 2.2 (P = .011) and 4.3 vs 6.5 (P = .003), respectively. Regional anesthesia is effective at controlling perioperative pain and is an alternative with a low complication rate for patients who cannot tolerate moderate sedation.
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Affiliation(s)
- Dalen Kuang
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, California.
| | - Ryan Chao
- Community Radiology Division at ValleyCare Hospital, Stanford Health Care, Pleasanton, California
| | - Jiwon Youm
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, California
| | - Stephen Hugdal
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, California
| | - Brett Miller
- Department of Anesthesia, Santa Clara Valley Medical Center, San Jose, California
| | - Jeffrey Sung
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, California
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Yang XY, Deng JB, An TZ, Zhou S, Li JX. Tumor enhancement ratio with unenhanced imaging is an independent prognostic factor for patients with hepatocellular carcinoma after transarterial chemoembolization. J Int Med Res 2021; 49:3000605211058367. [PMID: 34812068 PMCID: PMC8647277 DOI: 10.1177/03000605211058367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective To investigative whether the odds tumor enhancement ratio (OTER) on
cross-sectional imaging is a prognostic factor for hepatocellular carcinoma
after transarterial chemoembolization (TACE). Methods This study involved 126 patients who underwent TACE from May 2015 to March
2019. The signal intensity/Hounsfield units (HU) was measured by placing
regions of interest on the tumor and surrounding liver in unenhanced and
arterial-phase contrast-enhanced cross-sectional images. The OTER was
calculated as follows:
OTER = (HUTUMORart − HUTUMORun)/
(HULIVERart − HULIVERun). Univariate analysis was
performed to determine the factors associated with overall survival (OS).
Variables with a P value of <0.10 were included in the multivariate Cox
regression analysis. Results The median OS was 757 days. Tumors with a peripheral location, small size,
and low OTER had better OS than those with a central location, large size,
and high OTER. OS did not differ according to the extent of tumor
involvement or tumor enhancement pattern. The OTER, tumor location, and size
were included in the multivariate Cox regression analysis. A low OTER was
the predictor of better OS. Conclusion A high OTER is a risk factor for poor OS in patients undergoing TACE. This
should be taken into consideration before the procedure.
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Affiliation(s)
- Xi-Yuan Yang
- Department of Interventional Radiology, the Affiliated Baiyun Hospital of Guizhou Medical University, Guiyang, China
| | - Jiang-Bei Deng
- Department of Interventional Radiology, Changsha Central Hospital, University of South China, Changsha, China
| | - Tian-Zhi An
- Department of Interventional Radiology, 74720The Affiliated Hospital of Guizhou Medical University, the Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Shi Zhou
- Department of Interventional Radiology, 74720The Affiliated Hospital of Guizhou Medical University, the Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jun-Xiang Li
- Department of Interventional Radiology, Guizhou Medical University Affiliated Cancer Hospital, Guiyang, China
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