Could we Safely Perform Liver Ablation Without Deep Sedation or General Anesthesia? Preliminary Experience on Erector Spinae Plane Block (Espb) in the Management of Intra- and Post-Procedural Pain for Liver Microwave Ablation (with video).

PURPOSE: Liver microwave ablation (MWA) is typically performed under intravenous sedation or general anesthesia. The erector spinae plane block (ESPB) is a regional anesthetic technique that allows to achieve a multi-segmental and visceral sensory blockade. This study reports the preliminary experience with ESPB as the sole anesthetic technique for intra- and post-procedural pain management during MWA.

MATERIALS AND

METHODS

ESPB was proposed for patients deemed unfit for standard sedation or who refused it. Under ultrasound guidance, an anesthetic solution (ropivacaine 0.50% 30 ml, dexmedetomidine 20 µg, dexamethasone 4 mg) was injected into the fascial plane at T6-T9 level. Pain intensity was quantified through numerical rating scale (NRS). (NRS, 0-10). Adjunctive sedation (Diprivan) was administered if NRS reached > 3. Intra- and post-procedural pain, need for sedation, and analgesia were recorded.

RESULTS

Fifty-four patients underwent MWA with ESPB. The block provided sufficient anesthesia in 40/54 patients (74,1% of procedures) without any need for sedation; in 14/54 patients (25,9%), minimal adjunctive sedation was used. No mechanical ventilation was required. Mean NRS was 1.6 ± 2; post-procedural pain required only paracetamol in six patients (11.1%). Logistic regression identified left lobe lesions as predictive for adjunctive sedation need. All patients were discharged the following day.

CONCLUSION

ESPB alone provided adequate anesthesia for MWA in most patients, minimizing sedation needs and enabling safe, efficient procedures with early discharge.

LEVEL OF EVIDENCE: Level 4.