Editor, Anesthesiology section, BioMed Research International
Editor, Asian Journal of Anesthesiology
Director, Division of Clinical Anesthesia, Taipei Municipal Wanfang Hospital
Director, Pain Research Center, Taipei Municipal Wanfang Hospital
Associate Professor, Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Lead Guest Editor, RAPM Special Issue, BioMed Research International
Editor, Acta Anaesthesiologica Taiwanica
Director, Pain Management, Taipei Municipal Wanfang Hospital
Attending Physician, Department of Anesthesiology, Taipei Medical University Hospital
Attending Physician, Department of Anesthesiology, Tri-Service General Hospital
Regional Anesthesia and Pain Management for Percutaneous Radiofrequency Ablation of Liver Tumors
Percutaneous radiofrequency ablation (PRFA) of liver tumors has gained its popularity since it was recommended as the main ablative treatment for tumors less than 5 cm. Recently, the targets for liver PRFA underwent a transition from smaller toward larger and multiple lesions due to effectiveness and less invasiveness for patients with multiple comorbidities. Moreover, the technique also underwent a transition from intra-tumoral toward no-touch lesioning to prevent popcorn effect. Therefore, multiple co-axial needles at the same time are required to accomplish the missions, which challenges the perioperative management when it is performed under monitored anesthesia care.
Regional blocks are of utmost importance for stable maintenance during the ablative procedure as well as patient recovery. Knowledge of peri-hepatic innervation and adverse events caused by liver PRFA facilitates perioperative management. Abiding by physical ergonomics in the aseptic position, thoracic paravertebral block for corresponding innervation areas can be more easily carried out with visible ultrasound endpoints. Intractable referred shoulder pain following diaphragm irritation, uncommon but may happen, possibly requires phrenic nerve block to achieve adequate pain relief in the postoperative care unit. Under such circumstances, we recommend anterior scalene plane approach at the level of superior trunk with both ultrasound guidance and modified half-the-air setting to avoid potential complications such as incomplete analgesia when blocking it at the diaphragm level, unwanted extra-fascial spread, and, above all, nerve injury secondary to mechanical needle trauma, intra-fascicular injection as well as pressure-induced neuropraxia.