title: Thoracic paravertebral anesthesia for percutaneous radiofrequency ablation of hepatic tumors.
abstract: OBJECTIVE
  To present our preliminary experience using a thoracic paravertebral block (TPVB) as the sole anesthetic in percutaneous hepatic radiofrequency ablation (RFA).
  
  
  METHODS
  Retrospective case series of 12 ASA physical status 1, 2, and 3 patients of average risk scheduled for RFA.
  
  
  METHODS
  University medical center.
  
  
  METHODS
  The first 12 procedures performed using TPVB were analyzed to evaluate the efficacy and safety of this anesthetic technique. Data collected included patients' characteristics, procedure, pain referred during paravertebral punctures, and RFA (verbal numerical scale; VNS). Anesthesia and medical records also were reviewed for any major complications that occurred during or after the RFA.
  
  
  RESULTS
  Ten of the 12 patients presented for hepatocellular carcinoma; the other two patients had melanoma metastasis. Nine patients were ASA physical status 1 or 2; the other three patients were ASA physical status 3. Nine had liver cirrhosis. All patients had normal coagulation profiles. The TPVBs were performed in a median time of 6.5 (4-15) minutes. Onset of sensory loss to pinprick test occurred approximately 15 to 20 minutes after the injections. No evidence of bilateral blockade was seen in any patient. In most cases, the extent of anesthesia ranged from T6 to T11 or T12. In one patient (no. 2), the stimulating needle elicited no sensory or motor response at the T7 level; the local anesthetic was then injected one cm beyond the transverse process. All patients were very pleased with their anesthetic care; all were discharged from the hospital with no procedure-related complications.
  
  
  CONCLUSIONS
  The use of thoracic paravertebral block as the sole anesthetic for RFA of liver produced satisfactory unilateral anesthesia and minor adverse events.
authors.affiliation: Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy. Electronic address: federico.piccioni@istitutotumori.mi.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Piccioni
authors.affiliation: Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Fumagalli
authors.affiliation: Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Garbagnati
authors.affiliation: Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Tolla
authors.affiliation: Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mazzaferro
authors.affiliation: Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy; Department of Pathophysiology and Transplantation, University of Milan School of Medicine, Milan 20122, Italy.
authors.forename: Martin
authors.initials: M
authors.lastname: Langer
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008545:Melanoma / Q000473:pathology; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local
keywords: Liver neoplasms; Nerve block; Pulsed radiofrequency treatment; Radiofrequency ablation; Regional anesthesia; Thoracic paravertebral block