Paravertebral Block: An Improved Method of Pain Control in Percutaneous Transhepatic Biliary Drainage

Background and Purpose Percutaneous transhepatic biliary drainage remains a painful procedure in many cases despite the routine use of large amounts of intravenous sedation. We present a feasibility study of thoracic paravertebral blocks in an effort to reduce pain during and following the procedure and reduce requirements for intravenous sedation. Methods Ten consecutive patients undergoing biliary drainage procedures received fluoroscopically guided paravertebral blocks and then had supplemental intravenous sedation as required to maintain patient comfort. Levels T8–T9 and T9–T10 on the right were targeted with 10–20 ml of 0.5% bupivacaine. Sedation requirements and pain levels were recorded. Results Ten biliary drainage procedures in 8 patients were performed for malignancy in 8 cases and for stones in 2. The mean midazolam use was 1.13 mg IV, and the mean fentanyl requirement was 60.0 μg IV in the block patients. Two episodes of hypotension, which responded promptly to volume replacement, may have been related to the block. No serious complications were encountered. The mean pain score when traversing the chest wall, liver capsule, and upon entering the bile ducts was 0.1 on a scale of 0 to 10, with 1 patient reporting a pain level of 1 and 9 reporting 0. The mean peak pain score, encountered when manipulating at the common bile duct level or when addressing stones there, was 5.4 and ranged from 0 to 10. Conclusions Thoracic paravertebral block with intravenous sedation supplementation appears to be a feasible method of pain control during biliary interventions.     

Randomized double-blind trial of midazolam/placebo and midazolam/fentanyl for sedation and analgesia in lower-extremity angiography

Safety and efficacy of two drug regimens used for sedation and analgesia during lower-extremity angiography were studied. Midazolam (loading dose 14.5 micrograms/kg; maintenance dose, 7.2 micrograms/kg) with or without fentanyl (loading dose, 0.725 micrograms/kg; maintenance dose, 0.362 micrograms/kg) was administered in a blind fashion as an IV bolus to 50 patients. Hemodynamic responses were monitored, and a standardized questionnaire was given to the patient before, immediately after, and 8-24 hr after the procedure. Physicians also were asked questions after the procedure. Heart rate and oxygen saturation were not significantly different before and 2 min after administration or between groups. A small but significant decrease in blood pressure occurred 2 min after the loading dose was given in both groups. Both drug regimens had statistically significant anxiolytic effects; however, anxiolytic effects were superior in the midazolam/fentanyl group (p less than .02). Patients rated the overall effectiveness of anesthesia with midazolam/fentanyl as superior (p less than .02). Analysis of physicians' judgments of the effectiveness of sedation and analgesia showed a statistically significant advantage for the midazolam/fentanyl group (p less than .01). We conclude that midazolam/fentanyl appears to be as safe as and more efficacious than midazolam alone for sedation and analgesia during lower-extremity angiography.     

Sedation and analgesia in adult patients: evaluation of a staged-dose system based on body weight for use in abdominal interventional radiology

PURPOSE: To evaluate the safety and effectiveness of a systematic protocol for sedation and analgesia in interventional radiology. MATERIALS AND METHODS: Ninety-one adult patients underwent 113 abdominal interventional procedures. Fentanyl citrate and midazolam hydrochloride were administered in one to five steps (A, B, C, D, E) until the patient was drowsy and tranquil at the effective loading dose (ELD). Doses per step were as follows: A, fentanyl 1 microg per kilogram of body weight; B, midazolam 0.010-0.035 mg/kg; C, repeat dose in A; D, repeat half the dose in B; and E, midazolam 1-2-mg boluses (maximum, 0.15 mg/kg). RESULTS: The ELD was reached in no procedure after step A, in 70 after B, in 23 after C, and in 18 after D. Step E was needed in two procedures. The mean maximum pain score (scale of 0 to 10) was 3.4; pain scores in 85 (75%) procedures were 4 or less (discomforting). Severe pain occurred in seven (6%) procedures. Hypoxia (oxygen saturation < 90%) occurred in 11 (22%) procedures performed in patients breathing room air and four (6%) performed in those breathing supplemental oxygen (P: =.04). All patients responded to supplemental oxygen. CONCLUSION: This stepwise "ABCDE protocol" allows safe and effective sedation of patients. It is easy to use and may be useful in training radiology residents, staff, and nurses in the techniques of sedation and analgesia. Supplemental oxygen should be used routinely.     

Percutaneous Computed Tomography–guided Renal Mass Radiofrequency Ablation versus Cryoablation: Doses of Sedation Medication Used

PurposeTo compare the amount of sedation medication administered during radiofrequency (RF) ablation versus cryoablation of small renal masses.Materials and MethodsRecords were retrospectively reviewed in patients who underwent percutaneous computed tomography–guided RF ablation and cryoablation of small renal masses from January 2002 to June 2011 for patient and tumor characteristics, amount of medications used for moderate sedation, and complications. Sedation was performed by giving patients titrated doses of midazolam and fentanyl. Additional medications were given if the desired level of sedation was not achieved.ResultsThere were 116 patients who underwent 136 ablation procedures; 71 patients underwent RF ablation, and 65 patients underwent cryoablation. RF ablation was associated with a significantly higher mean dose of fentanyl (mean dose for RF ablation, 236.43 μg; mean dose for cryoablation, 172.27 μg; P<.001). RF ablation was also associated with a higher mean dose of midazolam (mean dose for RF ablation, 4.5 mg; mean dose for cryoablation, 3.27 mg; P<.001). In the RF ablation group, two patients required additional sedation with droperidol. As a result of oversedation, two patients in the RF ablation cohort required sedation reversal with naloxone and flumazenil. None of the patients who underwent cryoablation required sedation reversal. No other sedation-related complications occurred.ConclusionsCryoablation of small renal masses was performed with less sedation medication than RF ablation. This finding suggests renal cryoablation is less painful than RF ablation; however, prospective studies with validated pain scales are needed to confirm these results.     

Technique for providing analgesia during percutaneous biliary interventional procedures

AIMS: To evaluate the efficacy of interpleural analgesia during percutaneous transhepatic biliary procedures. METHOD: With the patient lying in the left lateral decubitus position a right sided interpleural catheter was sited at a chosen point between the 6th and 9th interspaces. Lignocaine was injected to provide a splanchnic and intercostal nerve block. The technique of interpleural block (IPB) is described. Assessment of the pulse, BP and O(2)saturation during the subsequent biliary procedure was made. The patient evaluated the maximum degree of pain felt during the biliary procedure according to a four-point pain scale (0-3). The nurse and radiologist also gave an objective assessment of the pain score. RESULTS: An IP catheter was successfully placed in 22 patients, one patient having the IPB on two occasions. Siting of the IP catheter failed in three patients. Good analgesia with no requirement for further analgesia or sedation was achieved in 11 patients on 12 occasions. Seven patients required additional small doses of analgesia for mild pain during the biliary procedure. IPB failed in four patients who required additional analgesia and sedation. No complication of the IPB technique occurred in our patient group. CONCLUSION: IPB is a safe and relatively effective method for analgesia during transhepatic percutaneous biliary procedures.     

Pain control requirements for percutaneous ablation of renal tumors: cryoablation versus radiofrequency ablation--initial observations

PURPOSE: To retrospectively compare the pain control requirements of patients undergoing computed tomography (CT)-guided percutaneous radiofrequency (RF) ablation with those of patients undergoing CT-guided percutaneous cryoablation of small (< or = 4-cm) renal tumors. MATERIALS AND METHODS: The study was HIPAA compliant and received institutional review board exemption; informed consent was not required. Medical and procedure records of patients who underwent RF ablation and cryoablation of renal tumors from June 19, 2003, to February 28, 2004, were retrospectively reviewed for clinical data, tumor characteristics, and anesthesia information. During the study period, 10 men (mean age, 66.5 years) underwent cryoablation of 11 renal lesions, and 14 patients (11 men, four women; mean age, 68.1 years) underwent RF ablation of 15 renal tumors. Analgesic and sedative requirements during the procedure were compared. Standard anesthesia consisted of 5 mL of 1% lidocaine injected locally, and conscious sedation consisted of 50 microg of fentanyl and 1 mg of midazolam administered intravenously. The Fisher exact test and Student t test were used to compare clinical factors and drug requirements between the two groups. RESULTS: There was no difference in terms of patient demographics, tumor diameter, or distribution of central versus noncentral lesions between the two groups. Cryoablation was associated with a significantly lower dose of fentanyl (165.0 microg [RF group] vs 75.0 microg [cryoablation group]; P < .001) and midazolam (2.9 mg [RF group] vs 1.6 mg [cryoablation group]; P = .026). In the RF group, one patient required general anesthesia, one patient required supplemental narcotics (5 mg of oxycodone) and sedatives (1 mg lorezapam), and one patient became apneic for a brief interval after receiving additional narcotics for pain during the procedure. An additional RF session was terminated early in one patient because of pain, and further medication could not be administered owing to bradycardia. No patients in the cryoablation group required any additional or alternate anesthetics. CONCLUSION: Image-guided percutaneous cryoablation of small (< or = 4-cm) renal lesions appears to require less analgesia than RF ablation. Prospective trials with validated pain scales are needed to examine this further.     

Chest pain following oesophageal stenting for malignant dysphagia

AIM: The palliative use of self-expanding metallic stents has been widely reported to relieve dysphagia in cases of oesophageal carcinoma. Little has been documented on the severity of chest pain following oesophageal stenting. The aim of this study was to investigate the association of pain with oesophageal stenting for malignant dysphagia. METHODS: Fifty-two patients with inoperable oesophageal carcinoma underwent stent placement between 1995-1999. Daily opioid analgesic requirements (mg of morphine equivalent doses) were monitored for 3 days before and 7 days after stenting. The degree of palliation was expressed as a dysphagia score (0-3). Hospital stay, readmission days, stent complications and patient survival time were also recorded. RESULTS: Twenty-six patients (50%) required opioid analgesia for chest pain (median dose: 80 mg morphine/day) within 48 h of the procedure compared to 11 (21.2%) patients before stenting (P = 0.0041). A significant increase was evident in the analgesic consumption following stent deployment (P < 0.001). The dysphagia score improved by a median value of 1 (CI 0.25)P < 0.001, with a re-intervention rate of 11.5%. The median survival time was 40 days post stenting (range 1-120). CONCLUSION: A significant proportion of patients developed chest pain after oesophageal stenting, requiring high dose opioid analgesia. As the origin of the pain is still unknown, pre-emptive analgesia may a play role in reducing stent-related morbidity and possibly in-hospital stay.     

Conscious sedation and analgesia for routine aortofemoral arteriography: a prospective evaluation

PURPOSE: To compare the effectiveness of temazepam and midazolam hydrochloride with or without fentanyl citrate versus a placebo in promoting patient acceptance of diagnostic aortofemoral arteriography. MATERIALS AND METHODS: One hundred twenty-five patients undergoing aortofemoral arteriography were prospectively and randomly assigned to one of four treatment arms: placebo (group A), oral temazepam (group B), intravenous midazolam (group C), or intravenous midazolam and fentanyl (group D). Patients were blinded to the administered sedative. Five-point scales were used to assess degree of patient discomfort, willingness to undergo the same procedure again, patient compliance, and preprocedural anxiety. RESULTS: There was no difference between patient groups in willingness to return for a repeat procedure (P: =.89). Group C patients were less compliant during the procedure (P: =.034). Mean patient discomfort scores were 1.81 for group A, 1.84 for group B, 1. 53 for group C, and 1.27 for group D. Discomfort experienced during the procedure was not related to the degree of preprocedural anxiety (P: =.42). Patients who had previously undergone arteriography reported a higher level of pain than did those who had not (P: =. 021). CONCLUSION: Most patients experienced only low-level discomfort during diagnostic aortofemoral arteriography. In the authors' opinion, conscious sedation should only be used selectively, not routinely, for diagnostic aortofemoral arteriography.     

Bispectral index monitoring for conscious sedation in intervention: better, safer, faster

AIM: The aim of this study was to compare subjective (Ramsay sedation score, RSS) with objective electroencephalogram-based bispectral index (BIS) assessment, and to validate the appropriate BIS range for measurement of conscious sedation in interventional procedures. MATERIALS AND METHODS: One hundred patients undergoing sedo-analgesia (midazolam and fentanyl) for interventional gastrointestinal procedures were divided into two groups. In group A (n=30) sedation was guided by the RSS with the operator blinded to the BIS recording. In group B (n=70) the operator titrated intravenous sedation to maintain an optimal BIS, predetermined from the results in group A. Recovery time, procedure duration, physiological parameters and unplanned events were recorded in both groups. RESULTS: There was a significant correlation between the BIS and RSS (p<0.001). BIS values of 87.2 and 80.9 corresponded to an RSS of 3 and 4, respectively. The optimal BIS level was defined as 80-85. Fifty-seven point five percent of readings were within this range in group B compared with 26.5% in group A (p<0.001). Sedation approaching general anaesthesia (BIS<60) occurred in 5.5% of patients in group A but not in group B. Mean recovery time, duration of procedure, midazolam and fentanyl doses were significantly reduced in group B. Unplanned events were reduced from 27 to 17%, but this was not statistically significant (p=0.29). CONCLUSION: BIS monitoring enables more effective titration of sedatives to maintain a suitable level of consciousness, whilst reducing procedure time. The BIS offers an objective, safe and reliable measure of sedation, without disturbing either patient or operator. BIS monitoring raises the standard of patient care, and in our view, should be used to augment standard assessment.     

Transrectal versus transvaginal abscess drainage: survey of patient tolerance and effect on activities of daily living.

PURPOSE: To evaluate patient perception of pain related to transrectal and transvaginal drainage and the catheter's effect on activities of daily living. MATERIALS AND METHODS: From July 1993 to August 1997, 22 male and 40 female patients (mean age, 41 years; age range, 4-80 years) underwent transrectal or transvaginal aspiration or drainage. Fifty-seven drainages were performed. In a follow-up survey, patients were asked to score pain experienced during the procedure and afterward on a scale of 1-10 and to rate the effect of the catheter on their activities of daily living. RESULTS: Twenty-two patients participated in the telephone survey. For those able to recall the insertion procedure, the mean pain score was 3.2 for transrectal and 5.9 for transvaginal drainage. Mean indwelling catheter pain was 1.6 for transrectal and 4.8 for transvaginal drainage. Pain after removal was 1.4 for transrectal and 2.3 for transvaginal drainage. Only one patient with a transrectal catheter reported severe limitation (bowel movement), with no reports of any serious effect on urinating, bathing, sitting, or walking. Transvaginally placed catheters caused marked limitation in all categories and were more painful than transrectal catheters (P < .05). CONCLUSION: Of the transrectal and transvaginal approaches, transrectal is better tolerated.     

Conscious sedation for patients undergoing enteroclysis: comparing the safety and patient-reported effectiveness of two protocols

Objective

To compare the safety and patient-reported effectiveness of two regimens for conscious sedation during enteroclysis.

Materials and methods

We surveyed two groups of outpatients and retrospectively reviewed procedure records for conscious sedation and complications. Patients were divided into Group One (received sedative/amnesic diazepam), and Group Two, (received amnesic/sedative, midazolam and analgesic fentanyl).

Results

All enteroclyses were successfully completed; there were no hospital admissions due to complications. In Group One (n = 106), mean dose of diazepam was 12.7 mg. 25% had oxygen desaturation (n = 25), and post-procedure vomiting without aspiration (n = 1). 56% of outpatients completed phone surveys, and 68% recalled procedural discomfort. In Group Two (n = 45), mean doses were 3.9 mg midazolam and 108 mcg fentanyl. 31% had desaturation (n = 13), and post-procedure vomiting without aspiration (n = 1). 87% had only a vague recall of the procedure or of any discomfort.

Conclusion

A combination of amnesic and fentanyl prevented the recall of discomfort of nasoenteric intubation and infusion in most patients who had enteroclysis compared to diazepam. Most of the patients would undergo the procedure again, if needed.     

Sedation with Propofol During Catheter-Directed Thrombolysis for Acute Submassive Pulmonary Embolism Is Associated with Increased Mortality

PurposeTo evaluate if sedation with propofol during catheter-directed thrombolysis (CDT) in patients with acute submassive pulmonary embolism (PE) affects survival.Materials and MethodsThis single-institution, retrospective study identified 136 patients from 2011–2017 who underwent CDT for acute submassive PE. Patients were grouped based on procedural sedation—propofol versus fentanyl and/or midazolam. Groups were compared for differences in baseline characteristics. Primary endpoint was in-hospital mortality. Logistic regression analysis was performed to evaluate for independent variables predictive of mortality. Propensity-matched analysis was also performed.ResultsPropofol was given to 18% (n = 25) of patients, and fentanyl and/or midazolam was given to 82% (n = 111) of patients. Mortality was 28% (n = 7) in the propofol group versus 3% (n = 3) in the fentanyl/midazolam group (P = .0003). Patients receiving propofol had 10.4 times the risk of cardiopulmonary arrest or dying during hospitalization compared with patients receiving fentanyl and/or midazolam (95% confidence interval, 2.9–37.3, P = .0003). The number needed to harm was 4 (95% confidence interval, 2.8–6.8). Logistic regression model analysis including Pulmonary Embolism Severity Index score, right-to-left ventricle diameter ratio and age was not predictive of mortality (P = .19). Adding type of sedation made the model predictive of mortality (P < .001). Propensity-matched analysis controlling for baseline differences in age, adjunctive maneuvers, American Society of Anesthesiologists class, and intubation before the procedure revealed that statistical significance between groups remained (P = .01).ConclusionsSedation with propofol during CDT for acute submassive PE is associated with increased mortality and should be used with caution.     

Intraarterial administration of lidocaine for analgesia in hepatic chemoembolization

Hepatic chemoembolization (HCE) routinely results in severe pain requiring massive doses of intravenously administered narcotics. This study examines the efficacy and safety of lidocaine administered intraarterially for analgesia in HCE. In 45 HCE procedures, lidocaine was injected into hepatic arterial branches just prior to and during chemoembolization. Adjunctive analgesic doses given during the procedure and the need for a morphine sulfate drip infusion for postprocedural pain control were recorded and compared with those in 20 procedures performed previously without lidocaine. In procedures with lidocaine, an average of 0.13 mg of morphine sulfate and 1.3 mg of midazolam were required. This is significantly lower than the 11.7 mg of morphine sulfate and 3.7 mg of midazolam used during procedures without lidocaine. A postprocedural morphine drip infusion was required for control of severe pain in 16 of 20 (80%) procedures performed without lidocaine compared with nine of 45 (20%) of those performed with lidocaine. Peripheral blood levels of lidocaine were well below the toxic level, and no complications referable to lidocaine toxicity occurred. Marked reductions in the amount of narcotic analgesia in HCE procedures may be safely achieved with the administration of intraarterial lidocaine.     

影响病人静脉芬太尼自控镇痛相关因素分析

目的　分析影响病人芬太尼静脉自控镇痛 (PCIA)的因素,提高术后镇痛的效果。方法　选择 60例ASA Ⅱ级实施下肢手术硬膜外麻醉病人,术后停止硬膜外给药,静脉负荷量为芬太尼 0. 1mg,接镇痛泵,镇痛液含 1mg芬太尼用生理盐水配成 100mg,背景输注量为2ml/h,指令剂量为 0. 5ml/次,锁定时间为 15min,分析手术类型、年龄、体质量和手术时间对镇痛效果的影响。以术后疼痛评分、镇静评分、PCIA按压次数、辅助镇痛药和病人呼吸次数、血压、心率、SPO2 及术后并发症评价镇痛的效果。结果　术后 24h时小手术的VAS评分低;大手术、年龄 <45岁,体质量 >70kg以上VAS评分高,PCIA按压次数多,辅助镇痛药多,不同性别,手术时间,硬膜外停药时间对病人术后VAS无明显影响。结论　手术的大小、病人的年龄和体质量是术后PCIA的影响因素,而性别和手术时间对术后PCIA无显著的影响。     

Sonography and MRI of the shoulder: comparison of patient satisfaction

OBJECTIVE: MRI and sonography are both used to evaluate patients with painful shoulders. This study was conducted to compare patients' perceptions and satisfaction with both tests. SUBJECTS AND METHODS: One hundred eighteen patients with shoulder pain and a clinically suspected rotator cuff tear underwent both MRI and sonography and filled out satisfaction surveys after both tests. Patients were asked the following questions: Did the test cause pain? If it did, they were asked to grade the pain on a scale of 1-10 (1, minimal pain; 10, severe pain). Did the test take too long? Would they be willing to undergo the test again? How would they grade their overall satisfaction with the test (1, poor; 2, fair; 3, good; 4, very good; and 5, excellent)? Which test did they prefer if both were equally accurate? RESULTS: Sonography caused pain above the baseline in 39 patients, with an average pain score (mean +/- SD) of 5.4 +/- 2.3, and MRI caused pain above the baseline in 40 patients, with an average pain score of 6.1 +/- 2.7 (p = 0.36). Two patients thought the sonography examination took too long, and 28 patients though the MRI examination was too long (p < 0.001). The average satisfaction level for sonography was 4.3 +/- 0.7 and for MRI, 3.6 +/- 1.2 (p < 0.001). The satisfaction score was higher for sonography in 54 patients, higher for MRI in 13 patients, and the same for both in 50 patients (p < 0.001). All patients were willing to repeat the sonography, but 10 patients were unwilling to repeat the MRI (p = 0.002). Ninety-three patients preferred sonography, eight patients preferred MRI, and 17 patients had no preference (p < 0.001). CONCLUSION: Most patients with shoulder pain prefer sonography to MRI.     

Painful metastases involving bone: feasibility of percutaneous CT- and US-guided radio-frequency ablation

PURPOSE: To determine the safety and efficacy of radio-frequency (RF) ablation for pain reduction, quality of life improvement, and analgesics use reduction in patients with skeletal metastases. MATERIALS AND METHODS: Over 10 months, 12 adult patients with a single painful osteolytic metastasis in whom radiation therapy or chemotherapy had failed and who reported severe pain (pain score > or = 4 [scale of 0-10]) over a 24-hour period were treated with percutaneous imaging-guided RF ablation with a multi-tined electrode while under general anesthesia. Patient pain was measured with a Brief Pain Inventory 1 day after the procedure, every week for 1 month, and thereafter every other week (total follow-up, 6 months). Patient analgesics use was also recorded at these follow-up intervals. Follow-up contrast material-enhanced computed tomography was performed 1 week after the procedure. Complications were monitored. Analysis of the primary end point was undertaken with paired comparison procedures. RESULTS: Lesion size was 1-11 cm. Before RF ablation, mean worst pain score in a 24-hour period in 12 patients was 8.0 (range, 6-10). At 4 weeks after treatment, mean worst pain decreased to 3.1 (P =.001). Mean pain before treatment was 6.5 and decreased to 1.8 (P <.001) 4 weeks after treatment. Mean pain interference in general activity decreased from 6.6 to 2.7 (P =.002) 4 weeks after treatment. Eight of 10 patients using analgesics reported reduced use at some time after RF ablation. No serious complications were observed. CONCLUSION: RF ablation of painful osteolytic metastases is safe, and the relief of pain is substantial.     

Music during interventional radiological procedures, effect on sedation, pain and anxiety: a randomised controlled trial

Objective

: To assess the effects of playing patient-selected music during interventional procedures on (1) the doses of sedation and analgesia and (2) anxiety levels.

Methods

: Patients undergoing interventional radiological procedures were randomised to either the intervention (music) or the control (no music) group. Patients in the intervention group had music of their choice played via headphones during the procedure. The primary outcomes were reductions in the doses of drugs for sedation (midazolam) and analgesia (fentanyl). Anxiety levels were assessed both before and after the procedure using the validated State Anxiety Inventory. Mean pulse rate and average of mean blood pressures were also recorded before and during the procedures as surrogate indicators of anxiety levels.

Results

: 100 patients were randomised in a 1:1 ratio. There were 58 males and 42 females, with a mean age of 58 years. Sedation was required in 21 (42%) patients in the music group compared with 30 (60%) patients in the control group (p=0.046). The mean [standard deviation (SD)] midazolam dose was 2.1 mg (2.3 mg) in the control group and 1.3 mg (2.2 mg) in the music group (p=0.027). The mean (SD) fentanyl dose was 29 mg (40 mg) in the control group and 18 mg (34 mg) in the music group (p=0.055). There was no significant effect of music on the change from baseline in anxiety levels (p=0.74), pulse rate (p=0.56) or blood pressure (p=0.34).

Conclusion

: Sedation requirements are significantly reduced by playing self-selected music to the patient during interventional radiology procedures. By lowering sedation during interventional radiology, music makes the procedure safer. It also contributes favourably to the overall patient experience.An increasing number of radiological interventional (IR) procedures, both vascular and non-vascular, are being performed worldwide. Most IR procedures are performed under local anaesthesia with a varying need for conscious sedation [1]. Conscious sedation carries small risks that are occasionally life threatening, e.g. respiratory depression [2]. Therefore the dose and need for conscious sedation should be minimised without compromising patient comfort during the procedure.Patients experience varying levels of anxiety before and during these procedures [3]. Factors known to reduce anxiety and analgesic requirements during procedures include adequate pre-operative information, with a pre-operative visit, and familiarity with the personnel involved. A meta-analysis of randomised trials concluded that music reduces anxiety and analgesic requirements during endoscopy [4].Playing music during the procedure is common practice in some IR radiology departments. This may not be directly for the patient''s benefit and they are often not consulted on the choice of music or offered headphones. One might expect a more patient-focused approach to reduce patient anxiety and pain. To our knowledge, the effect of music during IR procedures has not been investigated. The aim of this randomised study was to assess the effect of per-operative patient-selected music during IR procedures on:

1. dose of sedation and analgesic drugs
2. anxiety levels.

     

Combination of Microwave Ablation and Percutaneous Osteoplasty for Treatment of Painful Extraspinal Bone Metastasis

PurposeTo evaluate the efficacy and safety of microwave (MW) ablation combined with percutaneous osteoplasty (POP) on painful extraspinal bone metastases.Materials and MethodsIn this retrospective study, 50 adult patients with 56 extraspinal bone metastasis lesions, who suffered from refractory moderate to severe pain, were treated with MW ablation and POP. Changes in quality of life were evaluated based on the Visual Analog Scale (VAS), daily morphine consumption, and the Oswestry Disability Index (ODI) before and immediately after the procedure and during follow-up times.ResultsTechnical success was achieved in all patients. Mean preoperative VAS score and morphine dose were 7.0 ± 2.6 (range, 3–10) and 66.7 ± 33.2 mg (range, 10–120 mg), respectively. Mean postoperative VAS scores and daily morphine doses were as follows: 1 day, 3.5 ± 2.1 and 36.1 ± 25.8 mg (P < .05); 1 week, 1.5 ± 1.7 and 12.2 ± 14.8 mg (P < .001); 1 month, 0.9 ± 1.4 and 5.7 ± 10.0 mg (P < .001); and 3 months, 0.6 ± 1.2 and 4.7 ± 8.4 mg (P < .001). A significant decrease in the ODI score was also observed (P < .05). Periprocedural death was not observed. A pathologic fracture occurred in 1 (2%) patient with femoral metastasis, and local infection was observed in 2 (4%) patients. Minor cement leakage occurred in 4 (8%) patients with no symptomatic or intra-articular extravasation. No local tumor progression occurred in patients with imaging follow-up.ConclusionsMW ablation combined with POP is an effective and safe treatment for painful extraspinal bone metastases, which can significantly relieve pain and improve quality of life.     

芬太尼与曲马多术后镇痛的比较

目的：观察曲马多与芬太尼静脉PCA用于腹部手术病例术后镇痛的疗效、安全性及不良反应。方法：100例腹部手术病例随机分为芬太尼组（A组）和曲马多组B组）,每组各50例。镇痛开始后4,8、12、24、36和48h记录疼痛VAS评分、镇静程度评分、PcA按压次数、药物用量;记录不良反应发生例数。结果：两组疼痛评分、按压次数、镇静评分差别无统计学意义（P〉0．05）。结论：芬太尼与曲马多静脉PCA均可安全、有效地应用病人术后镇痛。     

小剂量硫酸镁复合芬太尼术后静脉镇痛

目的比较小剂量硫酸镁联合芬太尼与单纯芬太尼术后静脉镇痛的临床效应。方法选择行上腹部手术后患者90例,随机均分为三组,每组30例,以一次性静脉镇痛泵(2m l/h)分别行静脉术后镇痛,F组:单纯芬太尼镇痛,0.2μg/(kg.h)芬太尼+5 mg氟哌利多,MF1组:硫酸镁联合芬太尼镇痛,0.2μg/(kg.h)芬太尼+0.5 mg/(kg.h)硫酸镁+5 mg氟哌利多,MF2组:硫酸镁联合芬太尼镇痛,0.2μg/(kg.h)芬太尼+1 mg/(kg.h)硫酸镁+5 mg氟哌利多,各组镇痛泵中药物均用医用盐水稀释至100 m l,观察各组患者镇痛48 h内的静息镇痛评分(VAS方法),恶心呕吐,皮肤瘙痒和尿潴留的发生情况。结果三组患者的静息镇痛评分在12 h内MF1组和MF2组明显低于F组(P<0.05),而在12 h后没有明显差别(P>0.05);恶心呕吐,皮肤瘙痒和尿潴留发生率MF1组和MF2组显著低于F组(P<0.01)。MF1组和MF2组之间在静息镇痛评分和并发症发生方面没有明显差别。结论小剂量硫酸镁用于术后静脉镇痛可明显减少芬太尼的剂量,使恶心呕吐,皮肤瘙痒和尿潴留发生率降低,镇痛效果明显优于单纯芬太尼术后静脉镇痛。