Abstract：
OBJECTIVE: This study aims to assess the feasibility and safety of combined multiple regional anesthesia (CMRA) as a potential strategy to decrease pain and reliance on intravenous analgesics during and after ultrasound-guided microwave ablation (US-guided-MWA) of liver tumors.
METHODS: A cohort of 75 patients with a total of 99 liver tumors who underwent US-guided-MWA of liver tumors were enrolled. These patients were randomly allocated into three groups: A, B, and C. Prior to the ablation procedure, Group A patients received a combination of hepatic hilar block (HHB), Transversus abdominis plane block (TAPB), and local anesthesia (LA). Patients in Group B were administered HHB in conjunction with LA, while those in Group C received TAPB and LA. Evaluative parameters included the Numerical Rating Scale (NRS) scores, consumption of morphine, incidence of complications, and factors influencing perioperative pain.
RESULTS: All patients successfully underwent US-guided-MWA. The peak NRS scores for pain during ablation across the three groups were 2.36 ± 1.19, 3.28 ± 1.59, and 4.24 ± 1.42 respectively (P < 0.01), while the count of patients requiring morphine were 4/25, 8/25, and 13/25 respectively (P < 0.01). Postoperative NRS scores for the three groups at 4, 8, 12, 24, and 36-hour intervals demonstrated a pattern of initial increase followed by a decrease, with the order at each interval being: Group A < Group C < Group B. Factors associated with increased pain included larger tumor size, greater number of tumors, and longer procedure and ablation time (P < 0.05). No major complications were recorded across the three groups.
CONCLUSIONS: CMRA offers an effective and safe modality to manage pain during and after US-guided-MWA of liver tumors.
METHODS: A cohort of 75 patients with a total of 99 liver tumors who underwent US-guided-MWA of liver tumors were enrolled. These patients were randomly allocated into three groups: A, B, and C. Prior to the ablation procedure, Group A patients received a combination of hepatic hilar block (HHB), Transversus abdominis plane block (TAPB), and local anesthesia (LA). Patients in Group B were administered HHB in conjunction with LA, while those in Group C received TAPB and LA. Evaluative parameters included the Numerical Rating Scale (NRS) scores, consumption of morphine, incidence of complications, and factors influencing perioperative pain.
RESULTS: All patients successfully underwent US-guided-MWA. The peak NRS scores for pain during ablation across the three groups were 2.36 ± 1.19, 3.28 ± 1.59, and 4.24 ± 1.42 respectively (P < 0.01), while the count of patients requiring morphine were 4/25, 8/25, and 13/25 respectively (P < 0.01). Postoperative NRS scores for the three groups at 4, 8, 12, 24, and 36-hour intervals demonstrated a pattern of initial increase followed by a decrease, with the order at each interval being: Group A < Group C < Group B. Factors associated with increased pain included larger tumor size, greater number of tumors, and longer procedure and ablation time (P < 0.05). No major complications were recorded across the three groups.
CONCLUSIONS: CMRA offers an effective and safe modality to manage pain during and after US-guided-MWA of liver tumors.
摘要：
目的：本研究旨在评估联合多区域麻醉（CMRA）作为一种潜在策略的可行性和安全性，以减少超声引导下微波消融（US引导-MWA）肝肿瘤期间和之后的疼痛和对静脉镇痛药的依赖。
方法：纳入75例患者队列，共99例接受US指导的肝肿瘤MWA。这些患者被随机分为三组:A,B,和C.在消融手术之前，A组患者接受联合肝门阻滞（HHB），腹横肌平面阻滞（TAPB），和局部麻醉（LA）。B组患者与LA联合给予HHB，而C组患者接受了TAPB和LA。评价参数包括数值评定量表(NRS)得分，吗啡的消费，并发症的发生率，围手术期疼痛的影响因素。
结果：所有患者均成功接受了US指导的MWA。三组消融期间疼痛的NRS评分峰值分别为2.36±1.19、3.28±1.59和4.24±1.42(P<0.01)。需要吗啡的患者分别为4/25、8/25和13/25（P<0.01）。三组在术后4、8、12、24和36小时的NRS评分显示出最初增加，然后下降的模式。每个间隔的顺序为：A组结论：CMRA提供了一种有效且安全的方式来管理US指导的肝肿瘤MWA期间和之后的疼痛。
方法：纳入75例患者队列，共99例接受US指导的肝肿瘤MWA。这些患者被随机分为三组:A,B,和C.在消融手术之前，A组患者接受联合肝门阻滞（HHB），腹横肌平面阻滞（TAPB），和局部麻醉（LA）。B组患者与LA联合给予HHB，而C组患者接受了TAPB和LA。评价参数包括数值评定量表(NRS)得分，吗啡的消费，并发症的发生率，围手术期疼痛的影响因素。
结果：所有患者均成功接受了US指导的MWA。三组消融期间疼痛的NRS评分峰值分别为2.36±1.19、3.28±1.59和4.24±1.42(P<0.01)。需要吗啡的患者分别为4/25、8/25和13/25（P<0.01）。三组在术后4、8、12、24和36小时的NRS评分显示出最初增加，然后下降的模式。每个间隔的顺序为：A组
