1
|
Joseph N, Sun VH, Som A, Di Capua J, Elsamaloty L, Huang J, Vazquez R. Evaluation of paravertebral blocks in improving post-procedural pain and decreasing hospital admission after microwave ablation of liver tumors. Sci Rep 2023; 13:13854. [PMID: 37620391 PMCID: PMC10449898 DOI: 10.1038/s41598-023-36607-1] [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: 11/30/2022] [Accepted: 06/07/2023] [Indexed: 08/26/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Nicholos Joseph
- Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | - Virginia H Sun
- Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | - Avik Som
- Division of Vascular and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - John Di Capua
- Division of Vascular and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Lina Elsamaloty
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Junjian Huang
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, USA
| | - Rafael Vazquez
- Department of Anesthesiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| |
Collapse
|
2
|
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.
Collapse
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.)
| |
Collapse
|