Thoracic paravertebral block for analgesia following liver mass radiofrequency ablation.

A 66-year-old man presented for a second attempt of radiofrequency ablation of a metastatic carcinoid liver lesion. The first attempt using intravenous sedation was unsuccessful because of inadequate pain control and subsequent patient combativeness. Despite fentanyl being given during general anaesthesia, the patient complained of severe right flank pain after emergence. A thoracic paravertebral block was performed without complication and the patient's pain decreased to "3 out of 10" on a standard 10-point scale after 10 min, and "0 out of 10" after 30 min. The patient's pain score remained 0 throughout the following day, and no further analgesics were required. Thoracic paravertebral block can provide complete and lasting analgesia following hepatic radiofrequency ablation, and warrants further study for patients undergoing hepatic radiological interventions.

[1]  P. Myles,et al.  A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy--a systematic review and meta-analysis of randomized trials. , 2006, British journal of anaesthesia.

[2]  W. Culp,et al.  Paravertebral Block: An Improved Method of Pain Control in Percutaneous Transhepatic Biliary Drainage , 2006, CardioVascular and Interventional Radiology.

[3]  F. Ziade,et al.  Thoracic Paravertebral Block: Influence of the Number of Injections , 2005, Regional Anesthesia & Pain Medicine.

[4]  W. Culp Thoracic paravertebral block for percutaneous transhepatic biliary drainage. , 2005, Journal of vascular and interventional radiology : JVIR.

[5]  H. Rhim Complications of radiofrequency ablation in hepatocellular carcinoma , 2005, Abdominal Imaging.

[6]  Thomas J Vogl,et al.  Image-guided tumor ablation: proposal for standardization of terms and reporting criteria. , 2003, Radiology.

[7]  A. Platts,et al.  The role of anaesthesia in interventional radiology , 2002 .

[8]  M. Karmakar Thoracic Paravertebral Block , 2001, Anesthesiology.

[9]  L. Castéra,et al.  Pain experienced during percutaneous liver biopsy , 1999, Hepatology.

[10]  A. Leach,et al.  Paravertebral block in the management of liver capsule pain after blunt trauma. , 1999, British journal of anaesthesia.

[11]  D. Ilsley,et al.  A thermographic study of paravertebral analgesia , 1995, Anaesthesia.

[12]  S. Teplick,et al.  Pain control during interventional biliary procedures: epidural anesthesia vs i.v. sedation. , 1993, AJR. American journal of roentgenology.

[13]  S. Trerotola,et al.  Randomized double-blind clinical trial of celiac plexus block for percutaneous biliary drainage. , 1993, Journal of vascular and interventional radiology : JVIR.