Abstract

Background: Percutaneous ablation of renal carcinoma is frequently a favourable treatment alternative, especially in elderly patients suffering from co-morbidities. Also, it is less resource-demanding than conventional surgery of renal carcinoma, and one may, therefore, assume that the incidence of this procedure may increase. Analgesia is necessary during this intervention. The aim of this study was to explore the possibility of analgosedation and its relation to patient comfort and safety during percutaneous ablation of renal carcinoma.

Methods: Forty-six patients, sedated with dexmedetomidine and remifentanil, supplemented with infiltration anaesthesia (lidocaine 1%), underwent percutaneous (radiofrequency or microwave) ablation of renal carcinoma in this prospective study.

Results: The patients expected pain intensity around the numerical rating score (NRS) 4.5 (interquartile range [IQR] 3.5–5.5), which was slightly lower than pain experienced during the procedure NRS 5 (IQR 2–7; p = 0.49). Eight percent of the patients needed supplementary morphine during the ablation procedure. Sedation score did not differ during ablation, at arrival to or discharge from the recovery ward. Median periprocedural treatment time was 12 minutes (IQR 12–16). Treatment time did not correlate with experienced pain (R²=0.000074, p = 0.96). The median length of stay in the recovery room was 120 minutes (IQR 84–154). There were seven serious adverse events.

Conclusions: This proof-of-concept study has shown that analgosedation during percutaneous ablation of renal carcinoma can be performed with a generally tolerable degree of patient satisfaction. However, pain occurs and should be managed adequately. Patient safety must be a major concern for the anaesthetic care.

摘要

背景：肾癌的经皮消融术通常是一种有利的治疗选择，尤其是在患有合并症的老年患者中。而且，它比常规的肾癌手术对资源的需求少，因此可以认为这种手术的发生率可能增加。在这种干预过程中，镇痛是必要的。这项研究的目的是探讨经皮消融术在肾癌消融术中止痛的可能性及其与患者舒适度和安全性的关系。

方法：本项前瞻性研究对46例右美托咪定和瑞芬太尼镇静，并辅以浸润麻醉（1％利多卡因）的患者，经皮（射频或微波）消融肾癌。

结果：患者预期的疼痛强度在数字评分（NRS）4.5（四分位间距[IQR] 3.5-5.5）附近，略低于NRS 5的疼痛程度（IQR 2-7；p  = 0.49）。百分之八的患者在消融过程中需要补充吗啡。消融期间，到达康复病房或从康复病房排出时的镇静分数没有差异。围手术期中位治疗时间为12分钟（IQR 12-16）。治疗时间与经历的疼痛无关（R ² = 0.000074，p  = 0.96）。在康复室的平均住院时间为120分钟（IQR 84–154）。有七个严重的不良事件。

结论：这项概念验证研究表明，经皮消融肾癌期间的止痛可以使患者满意，通常可以忍受。但是，会发生疼痛，应适当处理。患者安全必须是麻醉护理的主要关注点。