title: Prevention of vagotonia and pain during radiofrequency ablation of liver tumors.
abstract: Radiofrequency ablation (RFA) is frequently used to treat early stage hepatocellular carcinoma. Two of the most cumbersome side-effects of the ablation procedure are intractable pain and vagotonia when deep sedation is not used. We describe local injection of anesthetic into Glisson's sheath as a new technique for overcoming these problems. Lidocaine was injected into Glisson's sheath when radiofrequency ablation of hepatocellular carcinomas, which were located adjacent to Glisson's sheath, could not be continued due to severe pain (n = 8) or bradycardia (n = 3). In all three patients who showed vagotonia with bradycardia during the ablations, injection of lidocaine prevented bradycardia, allowing completion of the radiofrequency ablation. Pain was reduced in all eight patients who experienced pain during ablation. No side-effects were observed during the procedures. Injection of anesthetic into Glisson's sheath is simple and effective for reducing intractable pain and vagotonia associated with RFA.
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Nakamura
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nouso
authors.forename: Hideki
authors.initials: H
authors.lastname: Onishi
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuwaki
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hagihara
authors.forename: Yasuto
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Nozomu
authors.initials: N
authors.lastname: Wada
authors.forename: Yuki
authors.initials: Y
authors.lastname: Morimoto
authors.forename: Koji
authors.initials: K
authors.lastname: Miyahara
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yasunaka
authors.forename: Fusao
authors.initials: F
authors.lastname: Ikeda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Miyake
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Hidenori
authors.initials: H
authors.lastname: Shiraha
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Akinobu
authors.initials: A
authors.lastname: Takaki
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
keywords: complications; hepatocellular carcinoma; pain; radiofrequency ablation