Our study found that PVB in Percutaneous HCC thermoablation is an effective, safe and well-evaluated technique for patients and surgeons.
Despite an increase in the total waiting time for anaesthesia, the impact on surgeons' satisfaction was between the years and the postoperative period, in which they significantly better evaluated the working conditions of the PVB group.
The average duration of the PVB was 15 min. and the duration of the blockade-18 min. Piccioni et al. Performed PVB in 6.5 minutes using the peripheral nerve stimulator. Anesthesia occurred in this case after 15–20 min, using 0.5% levobupivacaine [12]. The level of sympathetic blockade was sufficient to carry out the procedure on average after 25 min. Most authors give a range of 15–30 min. [13.14], which may arise from the experience of anaesthesiologist performing PVB and used imaging technique, and anesthetic drug. In our case, all patients were visualized using ULTRASOUND. Shorter blockage time was obtained by cHeung Ning and M Karmakar, studying a group of 20 patients. They used ropivacaine 0.75% by obtaining a sensory lock after 10 min. from the implementation of PVB [10]. Mohamed et al. Obtained anation after 10 min. from the performance of PVB using as in our case 0,5% bupivacaine, but in a volume of 25 ml [15]. Summing up the duration of the blockade and the achievement of the appropriate level of anaesthesia, it appears to be adversely affected by the operational efficiency of the operation block, however, the benefits of perioperative conditions prevail in the assessment of surgeons and patients.
Surgeons have better appreciated the operating conditions in the PVB group. They particularly stressed that in this group the sick better cooperated during the whole procedure. Reduced pain in the case of PVB allowed for the reduction of analgosedation to a minimum, which significantly improved verbal contact with patients. Similar results were achieved by Gazzera et al. In 30 individuals, where 33, 3% of patients reported moderate pain during ablation by requiring additional intravenous sedation [16]. A description of 12 PVB cases can also be found in the literature without the need for additional analgosedation during the procedure [12].
PRV may cause shoulder pain due to irritation of the diaphragm nerve [17.18]. The use of shallow analgosedation in conjunction with regional or local anaesthesia seems to prevent this complication. In our work we did not observe this complication in any of the groups tested.
Most patients had a positive assessment of PVB, despite experiencing significantly greater discomfort at the time of exercise than in the non-blocking group. Interestingly, when comparing both groups, the level of patient satisfaction in both groups was similar.
During the postoperative period, the benefits of PVB significantly exceeded the disadvantages associated with its implementation. Patients in the PVB group felt much less pain than the control group. NRS at individual time points in no patients exceeded 5 points, reflecting the consumption of painkillers. In patients from the BB group, the strongest pain occurred in 1–3 hours after thermoablation, with a peak at 1 hour, in which the pain was assessed on an average of 6.2 points. This resulted in the quantity and quality of pain killers used. The patients in this group were required opioid drugs by most. In 24 hours after the treatment in group BB the pain was defined in the range 0–5, while in the PVB group 0–3.
When it comes to side effects, these include nausea and vomiting. The higher consumption of opioids in group BB influenced the increased incidence of post-operative nausea and vomiting, and probably pain-related discomfort also contributed to this. We did not observe the reflex vasovagal reaction in our patients after the performance of PVB.
In the literature, in the case of HCC thermoablation, a comparison of the PVB to epidural anaesthesia is often encountered. Data indicate that in the case of PVB there is a lower percentage of urine retention, postoperative nausea and vomiting and hypotension [19].
From a comparison of PVB to general anaesthesia, it is also apparent that, in the first case, hemodynamic stability, post-operative pain control and less nausea and vomiting are better [12, 20].
The interesting work was published by Renchun et al. In 2012, analysing the effect of the type of anaesthesia on the incidence of tumour recurrence and the survival time of patients with HCC. It has been found that the type of anaesthesia has no effect on the survival of patients, but general anaesthesia is associated with a higher incidence of tumour recurrence [21]. For similar applications came Yuang-Hung et al. by examining 118 patients [22].
Therefore, the choice of anaesthesia technique should take into account a whole range of factors and individualise the procedure depending on the specific case.