Clinical Study Of Perioperative Multimodal Pain Management By Thermal Ablation Of Liver Tumors

Objective To compare the safety and effectiveness of two kinds of perioperative analgesia for liver tumors,multi-mode analgesia and general intravenous anesthesia,and to preliminatively conclude a perioperative multi-mode analgesia program,and to analyze and summarize the related factors affecting the degree of pain during thermal ablation.Methods The data of patients who underwent thermal ablation of liver tumor in **Provincial People’s Hospital from November 2020 to January 2023 were obtained from the medical record management system.According to the analgesic methods adopted,the patients were divided into two groups: multi-mode group and intravenous group.The patients in the multi-mode group received thermal ablation of liver tumor under local anesthesia combined with intravenous hydromorphone for individualized analgesia,and the patients in the intravenous group received thermal ablation of liver tumor under general intravenous anesthesia and analgesia with self-preservation of respiration.All patient data were obtained from the medical record management system,including preoperative: patients’ general baseline data,preoperative self-assessment anxiety score(SAS),SAS grading,tumor location,diameter,type,and distance from liver capsule.Intraoperative: Ablation analgesia program,insertion depth of the ablation needle(distance from the tip of the needle to the skin during ablation),frequency of needle adjustment,ablation power and time,Blood pressure(systolic blood pressure,diastolic blood pressure,mean arterial pressure),oxygen saturation,heart rate,respiratory rate,multimodal VAS pain score,and operation time were measured at the time of entering the operating room(T0),at the beginning of puncture lesion(T1),at 5 minutes of ablation(T2),at the end of surgery(T3),and 30 minutes after surgery(T4).Postoperative:The duration of hospital stay and the satisfaction of the patient were recorded.By comparing the differences in the safety and analgesic effect of the two analgesic schemes,the influencing factors of patients’ intraoperative pain were analyzed by multiple linear regression,the linear regression equation model was established,and the fitting of the equation was tested.Results As of January 31,2023,a total of 60 patients were included in this study,and 60 lesions were ablated.Among them,30 cases were multimodal group and 30 cases were venous group.There were no significant differences in age,gender,preoperative SAS score,Child-Pugh grade of liver function,tumor type,diameter,lesion site and other clinical general data and clinical characteristics between the two groups(P>0.05),indicating comparability.Compared between the two groups,there were no significant differences in systolic blood pressure,diastolic blood pressure,mean arterial pressure,heart rate and respiratory rate between the multi-mode group and the venous group at the time of entering the operating room(T0),puncture(T1),ablation at 5 minutes(T2),at the end of surgery(T3),and 30 minutes after surgery(T4)(P>0.05).Oxygen saturation(Sp O2)at 5 min ablation(T2)was higher in the multimode group than in the venous group(Z=-2.136,P=0.033).Intragroup comparison,multimodal comparison throughout the procedure,There were no significant differences in systolic blood pressure,diastolic blood pressure,mean arterial pressure,heart rate,respiratory rate and oxygen saturation at the time of entering the operating room(T0),puncture(T1),ablation at 5 minutes(T2),at the end of surgery(T3)and 30 minutes after surgery(T4)(P>0.05).There were no significant differences in systolic blood pressure,diastolic blood pressure,mean arterial pressure,heart rate and respiratory rate in the venous group at four time points(P>0.05),but the blood oxygen saturation(Sp O2)at 5 minutes of ablation(T2)was lower than that at entering the operating room(T0)and puncture(T1)(P<0.05),respectively.Intraoperative VAS pain scores,the overall distribution of VAS pain scores at the time of entering the operating room(T0),at the time of puncture(T1),at the time of ablation for 5 minutes(T2),at the end of surgery(T3),and at the time of 30 minutes after surgery(T4)were statistically different in the multimode group(H=23.675,P<0.05).T2 was significantly higher than T0,T1 and T4(P<0.05).There was no significant difference between T2 and T3(P>0.05).VAS pain scores at T2 time points were selected as dependent variables,and multifactor linear regression analysis was performed by stepwise bidirectional screening.Finally,independent variables included in multivariate linear regression analysis were preoperative SAS score and tumor distance from liver capsule.The VAS pain score at T2 time point was used as the dependent variable,and preoperative SAS score and tumor distance from liver capsule were used as independent variables.Multiple linear regression equation was constructed: VAS=-3.665+0.155×SAS-0.055×D.There was no significant difference in postoperative complications,length of stay and patient satisfaction between the two groups(P>0.05),but the mean operation time of the multi-mode group was lower than that of the venous group(61.43±5.117 min vs 73.17±5.884 min,t=-8.241,P<0.001).Conclusion Multi-mode analgesia is a safe and effective perioperative analgesia program for thermal ablation of liver tumor,which can satisfy the perioperative analgesia of thermal ablation of liver tumor as well as general intravenous anesthesia,but the incidence of surgical complications is lower than that of general intravenous anesthesia.Preoperative patient anxiety score(SAS)and the distance between liver lesion and liver capsule are the main factors affecting the pain of thermal ablation of liver tumor.The selection of perioperative analgesic program for thermal ablation of liver tumor should be individualized considering patients’ general and economic conditions.