Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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The Effectiveness of Ultrasound-Guided Thoracic Paravertebral Block for Percutaneous Radiofrequency Ablation of Hepatic Tumors: A Pilot Study

간종양의 경피적 고주파 열치료에서 초음파 유도하 흉부 방척추블록의 효용성: 예비 연구

  • Kim, Hyungtae (Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Youngjun (Department of Radiology, Presbyterian Medical Center) ;
  • Kim, Beum Jin (Department of Radiology, Presbyterian Medical Center) ;
  • Shin, Sung In (Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center) ;
  • Yim, So Mang (Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center) ;
  • Lee, Ju-Hyung (Department of Preventive Medicine, Chonbuk National University Medical School)
  • 김형태 (울산대학교 의과대학 서울아산병원 마취통증의학교실) ;
  • 김영준 (예수병원 영상의학과) ;
  • 김범진 (예수병원 영상의학과) ;
  • 신성인 (예수병원 마취통증의학과) ;
  • 임소망 (예수병원 마취통증의학과) ;
  • 이주형 (전북대학교 의과대학 예방의학교실)
  • Received : 2018.05.09
  • Accepted : 2018.09.19
  • Published : 2018.12.01
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Abstract

Purpose: The purpose of this study was to evaluate the effectiveness of thoracic paravertebral block (TPVB) for management of pain during and after percutaneous radiofrequency ablation (RFA) of hepatic tumor. Materials and Methods: All patients were divided into non-TPVB (4 patients, 4 sessions of RFA for 4 tumors) and TPVB group (5 patients, 7 sessions of RFAs for 7 tumors). Ultrasound (US)-guided TPVB was performed at T7 level. The 15 mL of 0.375% ropivacaine was injected into right paravertebral space before RFA. If patients complained pain and asked analgesics or experienced pain with verbal numerical rating scale (VNRS) of more than 4, fentanyl $25{\mu}g$ (up to $100{\mu}g$), pethidine 25 mg, and midazolam 0.05 mg/kg (up to 5 mg) were sequentially given intravenously during RFA. Results: Total intravenous morphine equivalence of analgesics before, during, and after RFA was 129.1 mg and 0.0 mg in non-TPVB and TPVB group, respectively. Conclusion: US-guided TPVB may be an effective and safe anesthetic method for decreasing or eliminating pain during and after RFA for hepatic tumor and helpful in decreasing the usage of opioids.

목적: 간종양의 경피적 고주파 열치료(radiofrequency ablation, 이하 RFA) 도중 및 종료 후 발생하는 통증을 관리하는데 있어 흉부방척추블록(thoracic paravertebral block, 이하 TPVB)의 효용성을 평가하고자 하였다. 대상과 방법: TPVB를 시행하지 않은 그룹(4명; 4개 종양, 4회 RFA)과 시행한 그룹(5명; 7개 종양, 7회 RFA)으로 나누었다. 초음파 유도하 TPVB는 7번 흉추에서 시행하였다. 시술 전 우측 방척추 공간에 0.375% ropivacaine을 15 mL 주입하였다. 시술 중 환자가 통증을 호소하며 진통제를 요구하거나 구두통증척도(verbal numerical rating scale) 4점 이상의 통증을 호소하면 fentanyl $25{\mu}g$ (최대 $100{\mu}g$), pethidine 25 mg, midazolam 0.05 mg/kg (최대 5 mg)을 순차적으로 정맥 주입하였다. 결과: RFA 전, 도중, 후 사용된 진통제의 총 정맥 주입 모르핀 등가(total intravenous morphine equivalence)는 TPVB를 시행하지 않은 그룹에서는 129.1 mg이었고, 시행한 그룹에서는 0.0 mg이었다. 결론: 초음파 유도하 TPVB는 간종양의 RFA 도중 및 후에 발생하는 통증을 감소시키는데 효과적이고 안전한 방법일 수 있겠으며 마약성 진통제의 사용량을 줄이는데 도움이 될 것이다.

Keywords

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