Could we Safely Perform Liver Ablation Without Deep Sedation or General Anesthesia? Preliminary Experience on Erector Spinae Plane Block (Espb) in the Management of Intra- and Post-Procedural Pain for Liver Microwave Ablation (with video)

Purpose: Liver microwave ablation (MWA) is typically performed under intravenous sedation or general anesthesia. The erector spinae plane block (ESPB) is a regional anesthetic technique that allows to achieve a multi-segmental and visceral sensory blockade. This study reports the preliminary experience with ESPB as the sole anesthetic technique for intra- and post-procedural pain management during MWA. Materials and Methods: ESPB was proposed for patients deemed unfit for standard sedation or who refused it. Under ultrasound guidance, an anesthetic solution (ropivacaine 0.50% 30 ml, dexmedetomidine 20 µg, dexamethasone 4 mg) was injected into the fascial plane at T6–T9 level. Pain intensity was quantified through numerical rating scale (NRS). (NRS, 0–10). Adjunctive sedation (Diprivan) was administered if NRS reached > 3. Intra- and post-procedural pain, need for sedation, and analgesia were recorded. Results: Fifty-four patients underwent MWA with ESPB. The block provided sufficient anesthesia in 40/54 patients (74,1% of procedures) without any need for sedation; in 14/54 patients (25,9%), minimal adjunctive sedation was used. No mechanical ventilation was required. Mean NRS was 1.6 ± 2; post-procedural pain required only paracetamol in six patients (11.1%). Logistic regression identified left lobe lesions as predictive for adjunctive sedation need. All patients were discharged the following day. Conclusion: ESPB alone provided adequate anesthesia for MWA in most patients, minimizing sedation needs and enabling safe, efficient procedures with early discharge. Level of Evidence: Level 4.