The relief of body wall pain secondary to malignant hepatic metastases by intercostal nerve block with bupivicaine and methylprednisolone

Waldman, Steven D.; Feldstein, Gary S.; Donohoe, Charles D.; Waldman, Kathy A.

doi:10.1016/0885-3924(88)90136-4

Cited by 10 publications

(1 citation statement)

References 3 publications

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“…Thoracic paravertebral block (TPVB), is a well-established technique intended to anesthetize the spinal nerve roots and sympathetic chain in the paravertebral space and may provide unilateral chest and abdominal wall analgesia. The block has been used to control pain specifically of hepatic origin from tumor infiltration, 18 during percutaneous transhepatic biliary drainage 19 , 20 or following liver trauma. 21 Studies utilizing paravertebral and intercostal nerve block techniques have confirmed its value in decreasing narcotic requirements, decreasing pain prior, during, and following ablation, as well as increasing operator satisfaction.…”

Section: Techniquementioning

confidence: 99%

Optimized nerve block techniques while performing percutaneous hepatic ablation: Literature review and practical use

Liu

Hadjivassiliou

Valenti

et al. 2020

Journal of Interventional Medicine

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Percutaneous image guided thermal ablation has become a cornerstone of therapy for patients with oligometastatic disease and primary liver malignancies. Evolving from percutaneous ethanol injection (PEI), thermal ablation utilizing radiofrequency ablation (RFA) and microwave ablation (MWA) have become the standard approach in the treatment of isolated lesions that fit within the size criteria for curative intent therapy (typically 3-4cm). With the evolution of more intense thermal ablation, such as MWA, the dramatic increase in both the size of ablation zone and intensity of heat generation have extended the limits of this technique. As a result of these innovations, intra-procedural and post-procedural pain have also significantly increased, requiring either higher levels of intravenous sedation or, in some institutions, general anesthesia. In addition to the increase in therapeutic intensity, the use of intravenous sedation during aggressive ablation procedures carries the risk of over-sedation when the noxious insult (i.e. the ablation) is removed, adding further difficulty to post-procedural recovery and management. Furthermore, high subdiaphragmatic lesions become challenging in this setting due to issues relating to sedation and compliance with breath hold/breathing instructions. Although general anesthesia may mitigate these complications, the added resources associated with providing general anesthesia during ablation is not cost effective and may result in substantial delays in treatment. The reduction of Aerosol Generating Medical Procedures (AGMP), such as intubation due to the COVID-19 Pandemic, must also be taken into consideration. Due to the potential increased risk of infection transmission, alternatives to general anesthesia should be considered when safe and possible. Upper abdominal regional nerve block techniques have been used to manage pain related to trauma, surgery, and cancer; however, blocks of this nature are not well described in the interventional radiology literature. The McGill University group has developed experience in using such blocks as splanchnic, celiac and hepatic hilar nerve blocks to provide peri-procedural pain control [1]. Since incorporating these techniques (along with hydrodissection with tumescent anesthesia), we have also observed in our high volume ablation center a dramatic decrease in the amount of sedatives administered during the procedure, a decrease in patient discomfort during localization and ablation, as well as decreased pain post-procedure. Faster time to discharge and overall reduction in room procedural time serve as added benefits. The purpose of this publication is to outline and illustrate the practical application and use of nerve block/regional anesthesia techniques with respect to percutaneous hepatic thermal ablation.

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Section: Techniquementioning

confidence: 99%

Optimized nerve block techniques while performing percutaneous hepatic ablation: Literature review and practical use

Liu

Hadjivassiliou

Valenti

et al. 2020

Journal of Interventional Medicine

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A Review of Techniques of Intercostal Nerve Blocks

Elkhashab

Wang

2021

Curr Pain Headache Rep

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Subcutaneous tunneled intrapleural catheters in the long-term relief of right upper quadrant pain of malignant origin

Waldman¹,

Allen²,

Cronen³

1989

Journal of Pain and Symptom Management

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A 33-yr-old, 42-kg female, with extensive hepatic metastatic disease with intractable pain unresponsive to narcotic analgesics, nonsteroidal antiinflammatory drugs, and tricyclic antidepressants, is presented. Management of this patient's intractable pain with local anesthetics administered via a tunneled intrapleural catheter is discussed. Tunneling techniques are described. The patient continued to experience excellent pain relief at 6 wk follow-up.

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The relief of body wall pain secondary to malignant hepatic metastases by intercostal nerve block with bupivicaine and methylprednisolone

Cited by 10 publications

References 3 publications

Optimized nerve block techniques while performing percutaneous hepatic ablation: Literature review and practical use

Optimized nerve block techniques while performing percutaneous hepatic ablation: Literature review and practical use

A Review of Techniques of Intercostal Nerve Blocks

Subcutaneous tunneled intrapleural catheters in the long-term relief of right upper quadrant pain of malignant origin

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