Bipolar Radiofrequency Ablation of Painful Spinal Bone Metastases Performed under Local Anesthesia: Feasibility Regarding Patient’s Experience and Pain Outcome
Abstract
:1. Introduction
2. Materials and Methods
2.1. Procedure and Anesthesia
- Needle pathway local anesthetic injection (a mixture of fast- and slow-acting anesthetic (lidocaine hydrochloride 1% (1/3) and ropivacaine hydrochloride 0.25% (2/3): from skin entry point to tumor, associated to an intratumoral block with the same mixture. Quantities of injectant depended on both tumor size and patient’s tolerance, without exceeding dose limits [10].
- Inhalation of nitrous oxide throughout the procedure.
- IV administration of paracetamol (1 g) started 5 min prior to procedure. IV injection of nalbuphin (20 mg) could be added on demand in case of persisting pain.
2.2. RFA Technique
2.3. Pain Assessment
3. Statistical Analysis
4. Results
4.1. Procedure
4.2. Pain
5. Discussion
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Sex/Age | Primary | Lesion Level | Size (mm) | Type | Soft-Tissue Involvement | Posterior Wall Involvement | Cementoplasty |
---|---|---|---|---|---|---|---|
1-M/46 | melanoma | body T6 | 16 × 25 × 12 | lytic | no | yes | yes |
2-M/54 | lung | body L1 | 29 × 35 × 13 | lytic | no | no | yes |
3-M/58 | lung | body L2 | 30 × 30 × 26 | lytic | no | no | yes |
4-M/56 | lung | body T7 | 15 × 26 × 13 | lytic | no | no | yes |
body T8 | 17 × 28 × 12 | lytic | no | no | yes | ||
5-F/75 | lung | body L1 | 61 × 58 × 20 | lytic | yes | yes | yes |
6-F/55 | lung | body L5 | 25 × 12 × 33 | lytic | yes | no | yes |
7-M/60 | lung | pedicle L T12 | 54 × 32 × 20 | lytic | yes | no | no |
8-M/72 | lung | R Transverse process T5 | 16 × 19 × 13 | lytic | yes | no | no |
9-M/59 | lung | body T10 | 32 × 35 × 20 | lytic | yes | no | yes |
10-M/76 | prostate | body L3 | 32 × 27 × 19 | osteoblastic | no | yes | yes |
11-M/56 | urothelial | body L3 | 13 × 13 × 12 | lytic | yes | no | no |
12-M/74 | prostate | body T9 | 16 × 19 × 12 | osteoblastic | no | yes | no |
13-M/59 | kidney | body L2 | 14 × 15 × 14 | lytic | yes | no | yes |
14-M/44 | head and neck | body T12 | 15 × 13 × 8 | osteoblastic | no | no | no |
15-M/61 | hepatocellular carcinoma | pedicle L L5 | 38 × 47 × 22 | lytic | yes | yes | no |
pedicle L L4 et L5 | 54 × 30 × 33 | lytic | yes | yes | no | ||
16-F/57 | breast | body T12 | 40 × 57 × 11 | mixt | no | no | yes |
17-M/75 | pancreas | R pedicle C7/T1 | 55 × 44 × 40 | lytic | yes | yes | no |
18-M/63 | lung | pedicle R L2 | 15 × 20 × 16 | lytic | no | yes | no |
19-F/69 | neuroendocrine | sacrum L S1 | 28 × 31 × 20 | lytic | no | no | no |
20-M/61 | pancreas | body L2 | 45 × 40 × 22 | lytic | no | no | yes |
21-F/35 | breast | body L3 | 25 × 29 × 21 | lytic | no | no | yes |
22-F/46 | colorectal | body L4 | 22 × 38 × 24 | lytic | yes | no | yes |
SI right | 19 × 30 × 18 | lytic | no | no | yes | ||
23-M/76 | colorectal | body L1 | 21 × 18 × 13 | lytic | no | no | yes |
24-M/63 | colorectal | L Transverse process T6 | 10 × 10 × 10 | lytic | yes | no | no |
25-F/66 | colorectal | sacrococcygeal | 56 × 55 × 71 | lytic | yes | yes | no |
colorectal | sacrococcygeal | 50 × 56 × 45 | lytic | yes | yes | no |
Patient | VAS Scores | Tolerance | |||||
---|---|---|---|---|---|---|---|
Before Procedure | 24 h | 1 Month | 3 Month | 6 Month | 12 Month | ||
1 | 10 | 5 | 0 | 1 | 2 | _ | 1 |
2 | 10 | 1 | 2 | 0 | 0 | _ | 0 |
3 | 9 | 2 | 1 | 3 | 4 | 0 | 0 |
4 | 9 | 2 | 2 | 0 | 0 | 0 | 1 |
8 | 0 | 0 | 0 | _ | _ | 1 | |
5 | 10 | 1 | 0 | 2 | 1 | 0 | 0 |
6 | 9 | 4 | 0 | 4 | 5 | lost | 0 |
7 | 9 | 7 | 0 | 6 | 3 | 4 | 0 |
8 | 10 | 0 | 9 | 7 | _ | _ | 1 |
9 | 10 | 7 | 3 | _ | _ | _ | 1 |
10 | 9 | 2 | 0 | 0 | 4 | 4 | 1 |
11 | 8 | 0 | 0 | 4 | 2 | 3 | 1 |
12 | 8 | 0 | 0 | 0 | 0 | 0 | 0 |
13 | 9 | 0 | 3 | 0 | 0 | 5 | 0 |
14 | 6 | 0 | 0 | 0 | 0 | 0 | 0 |
15 | 8 | 3 | 4 | 4 | 0 | 0 | 1 |
4 | 4 | 4 | _ | _ | _ | 0 | |
16 | 8 | 0 | 0 | 0 | 2 | _ | 1 |
17 | 8 | 8 | 8 | _ | _ | _ | 2 |
18 | 7 | 4 | 3 | _ | _ | _ | 0 |
19 | 9 | 2 | 3 | 1 | 0 | 0 | 1 |
20 | 6 | 0 | 0 | _ | _ | _ | 0 |
21 | 9 | 0 | 2 | 4 | 5 | 5 | 0 |
22 | 9 | 1 | 2 | 1 | 3 | 1 | 0 |
9 | 2 | 1 | 2 | 2 | 2 | 1 | |
23 | 9 | 4 | 0 | 0 | 1 | _ | 1 |
24 | 8 | 4 | 3 | 3 | 3 | 3 | 0 |
25 | 9 | 1 | 2 | 0 | 0 | 0 | 0 |
8 | 0 | 0 | 0 | _ | _ | 0 | |
Mean | 8.4 | 2.2 | 1.8 | 1.8 | 1.9 | 1.8 | |
Standard Deviation | ±1.4 | ±2.4 | ±2.3 | ±2.2 | ±1.8 | ±2.1 |
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Kastler, A.; Barbé, D.-A.; Alemann, G.; Hadjidekov, G.; Cornelis, F.H.; Kastler, B. Bipolar Radiofrequency Ablation of Painful Spinal Bone Metastases Performed under Local Anesthesia: Feasibility Regarding Patient’s Experience and Pain Outcome. Medicina 2021, 57, 966. https://doi.org/10.3390/medicina57090966
Kastler A, Barbé D-A, Alemann G, Hadjidekov G, Cornelis FH, Kastler B. Bipolar Radiofrequency Ablation of Painful Spinal Bone Metastases Performed under Local Anesthesia: Feasibility Regarding Patient’s Experience and Pain Outcome. Medicina. 2021; 57(9):966. https://doi.org/10.3390/medicina57090966
Chicago/Turabian StyleKastler, Adrian, Daniel-Ange Barbé, Guillaume Alemann, Georges Hadjidekov, Francois H. Cornelis, and Bruno Kastler. 2021. "Bipolar Radiofrequency Ablation of Painful Spinal Bone Metastases Performed under Local Anesthesia: Feasibility Regarding Patient’s Experience and Pain Outcome" Medicina 57, no. 9: 966. https://doi.org/10.3390/medicina57090966