Abstract

Introduction: High-intensity focused ultrasound (HIFU) for pancreatic cancer is a growing therapeutic field which has been proven to reduce cancer pain and provide a local tumor control additionally to standard palliative care. However, less is known about the multidisciplinary and especially anesthesiological management of HIFU treatment although an interdisciplinary approach is crucial for treatment success.

Material and methods: Anesthesiological and radiological records of 71 HIFU-treated pancreatic cancer patients were analyzed with regard to the following items: intervention time, sonication time, total energy, anesthesia time, peri-interventional medication, body temperature maximum and minimum, pain scores before and 1 day, 6 weeks and 3 months after intervention, peri-interventional complications. Effects on pain scores were estimated with a mixed panel data model. Bivariate associations between interventional variables were examined with the Spearman’s correlation.

Results: HIFU treatment was performed without major adverse events. Peri-procedural hyperthermia >37.5 °C occurred in 2 patients, hypothermia <35 °C in 8 cases. Interventional variables did not correlate significantly with pain scores, opioid dose, nor body temperature. 85.5% of patients experienced significant early pain relief within the first week after intervention. Post-interventional pain relief is associated with morphine equivalent opioid dose (p = 0.025) and treatment time (p = 0.040).

Conclusion: While HIFU can be considered safe and effective treatment option, procedure-associated pain and temperature management represent challenges for the interdisciplinary HIFU intervention team. Especially short-term pain relief depends on the combined effort of the radiologist and anesthesiologist.

摘要

简介：用于胰腺癌的高强度聚焦超声（HIFU）是一个正在发展的治疗领域，已被证明可减轻癌症疼痛并提供除标准姑息治疗外的局部肿瘤控制。但是，尽管跨学科方法对于治疗成功至关重要，但对HIFU治疗的多学科尤其是麻醉学管理知之甚少。

材料和方法：分析了71例接受HIFU治疗的胰腺癌患者的麻醉和放射学记录，涉及以下项目：干预时间，超声处理时间，总能量，麻醉时间，围手术期用药，体温最高和最低，疼痛评分干预前后，干预前后1天，6周和3个月。使用混合面板数据模型评估对疼痛评分的影响。干预变量之间的双变量关联用Spearman的相关性进行检验。

结果： HIFU治疗未发生重大不良事件。2例患者发生围手术期高温> 37.5°C，8例发生体温低于35°C。干预变量与疼痛评分，阿片类药物剂量或体温没有显着相关。85.5％的患者在干预后的第一周内经历了明显的早期疼痛缓解。干预后的疼痛缓解与吗啡等效阿片类药物剂量（p  = 0.025）和治疗时间（p  = 0.040）相关。

结论：虽然HIFU被认为是安全有效的治疗选择，但与过程相关的疼痛和温度管理仍是跨学科HIFU干预团队面临的挑战。特别是短期的疼痛缓解取决于放射科医生和麻醉师的共同努力。