Single needle versus double needle celiac trunk neurolysis in abdominal malignancy pain management: a randomized controlled trial / Neurólise do tronco celíaco com o uso de agulha única versus agulha dupla no manejo da dor abdominal maligna: estudo randômico controlado

Abstract Background: Computerized tomography-guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients' position and the double needle technique using posterior anterocrural approach. Methods: In Double Needles Celiac Neurolysis Group (n = 17), we used two needles posterior anterocrural technique injecting 12.5 mL phenol 10% on each side in prone position. In Single Needle Celiac Neurolysis Group (n = 17), we used single needle posterior anterocrural approach. 25 mL of phenol 10% was injected from left side while patients were in left lateral position then turned to right side. The monitoring parameters were failure block rate and duration of patient positioning, technique time, Visual Analog Scale, complications (hypotension, diarrhea, vomiting, hemorrhage, neurological damage and infection) and rescue analgesia. Results: The failure block rate and duration of patient positioning significantly increased in double needles celiac neurolysis vs. single needle celiac neurolysis (30.8% vs. 0%; 13.8 ± 1.2 vs. 8.9 ± 1; p = 0.046, p ≤ 0.001 respectively). Also, the technique time increased significantly in double needles celiac neurolysis than single needle celiac neurolysis (24.5 ± 5.1 vs. 15.4 ± 1.8; p ≤ 0.001). No significant differences existed as regards Visual Analog Scale: double needles celiac neurolysis = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) and single needle celiac neurolysis = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) after 1 day, 1 week, 1 and 3 months respectively. However, Visual Analog Scale in each group reduced significantly compared with basal values (p ≤ 0.001). There were no statistically significant differences as regards rescue analgesia and complications (p > 0.05). Conclusion: Single needle celiac neurolysis with changing patients' position has less failure block rate, less procedure time, shorter duration of patient positioning than double needles celiac neurolysis in abdominal malignancy.

Resumo Introdução: A neurólise do plexo celíaco guiada por tomografia computadorizada tornou-se uma técnica quase segura para aliviar a dor abdominal maligna. Comparamos a técnica de agulha única mudando o posicionamento do paciente e a técnica de agulha dupla usando a abordagem anterocrural posterior. Métodos: No grupo designado para neurólise celíaca com agulha dupla (n = 17), a técnica de abordagem anterocrural posterior foi utilizada com duas agulhas para injetar 12,5 mL de fenol a 10% de cada lado em decúbito ventral. No grupo designado para neurólise celíaca com agulha única (n = 17), a abordagem anterocrural posterior foi utilizada com uma única agulha para injetar 25 mL de fenol a 10% do lado esquerdo com o paciente em decúbito lateral esquerdo e posteriormente virado para o lado direito. Os parâmetros de monitorização foram a taxa de falha dos bloqueios e a duração do posicionamento dos pacientes, o tempo da técnica, os escores da escala visual analógica, as complicações (hipotensão, diarreia, vômitos, hemorragia, dano neurológico e infecção) e a analgesia de resgate. Resultados: A taxa de falha dos bloqueios e a duração do posicionamento dos pacientes aumentaram significativamente na neurólise celíaca com o uso de agulha dupla vs. agulha única (30,8% vs. 0%,13,8 ± 1,2 vs. 8,9 ± 1; p = 0,046, p ≤ 0,001, respectivamente). Além disso, o tempo da técnica foi significativamente maior na neurólise celíaca com agulha dupla que na neurólise celíaca com agulha única (24,5 ± 5,1 vs. 15,4 ± 1,8; p ≤ 0,001). Não houve diferença significativa em relação aos escores da escala visual analógica: neurólise celíaca com agulha dupla = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) e neurolise celíaca com agulha única = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) após um dia,uma semana, um e três meses, respectivamente. No entanto, os escores da escala visual analógica para cada grupo foram significativamente menores comparados aos valores basais (p ≤ 0,001). Não houve diferença estatisticamente significativa quanto à analgesia de resgate e complicações (p > 0,05). Conclusão: A neurólise celíaca com o uso de agulha única e a alteração do posicionamento do paciente apresenta uma taxa menor de falha do bloqueio, menos tempo de procedimento e menor duração do posicionamento do paciente que o uso de duas agulhas para neurólise celíaca em malignidade abdominal.

Short-term efficacy of ultrasound-guided percutaneous ethanol injection enhanced single needle radiofrequency ablation in the treatment of liver cancer / 中华消化外科杂志

ObjectiveTo investigate the short-tern efficacy of ultrasound-guided percutaneous ethanol injection (PEI) enhanced single needle radiofrequency ablation ( RFA) in the treatment of liver cancer.Methods The clinical data of 71 patients who were admitted to the Xijing Hospital from June 2010 to June 2011 were retrospectively analyzed.All patients were divided into the RFA group (25 patients ) and RFA + PEI group (46 patients).In the RFA group,the needle of RFA was injected into the tumor for coagulation with the guidence of ultrasound.In the RFA + PEI group,95％ ethanol was injected into the tumor with the guidence of ultrasound,and then RFA was performed.The tumor necrosis volumes of the 2 groups were assessed by contrast-enhanced ultrasound at 2 weeks after RFA.The relationship between the average RFA energy and volume of ethanol applied and necrosis volume was analyzed.All data were analyzed by using the chi-square test,t test and Pearson correlation coefficient.ResultsThe volume of coagulative necrosis of the RFA group was (22 ± 17) cm3,which was significantly smaller than (55 ± 44) cm3 of the RFA + PEI group (t =3.85,P ＜ 0.05 ).In the RFA + PEI group,the volume of ethanol injected was positively correlated with the volume of coagulative necrosis (r =0.615,t =5.86,P ＜ 0.05 ),but negatively correlated with the treatment efficacy ( r =- 0.709,t =- 7.52,P ＜ 0.05 ).The amount of required energy was positively correlated with the volume of coagulative necrosis (r =0.884,t =14.13,P ＜0.05 ),whereas no significant correlation was detected between the amount of required energy and the treatment efficacy ( r =- 0.225,t =- 1.72,P ＞ 0.05 ).The equation for calculating the volume of ethanol required was conducted:Y =2.526X - 2.693 [ Y:volume of ethanol required ( ml),X:diameter of the tumor (cm) ].Three patients in the RFA + PEI group were complicated by transient pain,flushing and cardiac acceleration after the operation,and the symptoms were alleviated by symptomatic treatment.The levels of transaninase were increased in the 3 groups,and then back to normal at 2 weeks after the treatment.No complications such as hepatic rupture,intestinal perforation,bile leakage or tumor implantation were detected in the 2 groups.The levels of alphafetoprotein (AFP) were significantly decreased.The AFP expressions of 20 patients (80％) in the RFA group and 39 patients (85％) in the RFA + PEI group changed to negative,with no significant difference between the 2 groups ( x2 =0.42,P ＞ 0.05 ).ConclusionPEI helps to increase the volume of coagulative necrosis and to reduce the energy requirement of routine RFA,and enhances the efficacy of single needle RFA.

Single needle running suture method for urethrovesical anastomosis during laparoscopic radical prostatectomy / 中华泌尿外科杂志

Objective To describe the single needle running suture method for the urethrovesi-cal anastomosis during laparoscopic radical prostatectomy(LRP). Methods Forty-five patients of prostate cancer underwent LRP with the single needle running suture method. The technique was initi-ated by performing a fixing suture at the posterior lip of bladder neck at 4 o' clock and tying the first knot. Another suture at the nearby position of the first suture was performed to leave the first knot outside. From 5 o' clock to 8 o' clock, sutures were performed every one o' clock to secure posterior approximation, then every two o'clock a suture. To avoid a loose anastomosis, lock sutures were per-formed every 3 sutures. After completing the full circumference, the needle was drawn at the 2 o' clock for the second knot. The needle was always driven full-thickness outside-in in the bladder neck and inside-out on the urethra. Any remaining leakage could be closed with additional interrupted su-tures. Results All urethrovesical anastomosis were completed successfully. The mean anastomosis time was 16 rain(from 12 to 25 min), and mean operative time was 132 rain (112 to 185 rain). The mean catheterization time was 9 d(7 to 14 d). Three temporal urinary leaks requiring prolonged cathe-terization were identified. Forty-four patients had total urinary control in 1 year postoperatively and no other short-term or persistent complication was found with a mean follow-up of 21 months. Conclu- sion The single needle running suture method could be a simple and safe method for urethrovesical anastomosis during LRP.