Surgical resection is the treatment of choice both for early-stage
lung cancer and pulmonary metastatic disease. For patients with lung
tumors who are not eligible for surgery, the minimally invasive modality of
radiofrequency ablation (RFA) may be curative and, thus, should be considered. However, opinions regarding the optimal
anesthetic technique for pulmonary RFA differ. Here the authors report their experience with the use of ultrasound-guided paravertebral block in minimally-sedated patients undergoing pulmonary RFA. This retrospective study was conducted at a single institution. The 17 consecutive patients underwent 19 pulmonary RFA procedures for primary lung
tumor or lung
metastases. In all patients, RFA was performed according to the protocol of the hospital.
Anesthesia in patients receiving RFA for lung
tumors consisted of a thoracic paravertebral block (TPVB), performed between T4 and T8, with minimal sedation. This approach allowed intraoperative communication with the patient and
apnea pauses as needed. There were no complications after TPVB, which was well-tolerated by all patients. Only two patients required an
alfentanil bolus during RFA because of pleuritic
pain. No patient required conversion from sedation to
general anesthesia. There were no episodes of hemodynamic instability or desaturation (SaO2 ≤95%), and excessive sedation prevented patient collaboration in only one patient. In conclusion, ultrasound-guided single-injection TPVB is a safe and effective
anesthetic technique for high-risk patients undergoing RFA for a primary lung
tumor or lung
metastases.