Abstract
BackgroundRemifentanil is widely used for ultrasound-guided percutaneous radiofrequency ablation (RFA) of small hepatocellular carcinoma (HCC). We determined whether dexmedetomidine could be an alternative to remifentanil for RFA of HCC under general anesthesia with sevoflurane.MethodsWe prospectively randomized patients scheduled to undergo RFA for HCC to a dexmedetomidine (DEX) group or remifentanil (REMI) group (47 patients each). In the DEX group, a bolus infusion (0.4 μg kg− 1) was started 15 min before anesthesia induction and continued at 0.2 μg kg− 1 h− 1 until 10 min before the end of surgery. In the REMI group, 3 μg kg− 1 h− 1 of remifentanil was administered from 15 min before anesthesia induction to the end of the surgery. The primary endpoint was postoperative pain intensity. Secondary endpoints included analgesic requirement, postoperative liver function, patient comfort, and hemodynamic changes. Group allocation was concealed from patients and data analysts but not from anesthesiologists.ResultsPostoperative pain intensity, analgesic consumption, comfort, liver function, and time to emergence and extubation did not differ between the two groups. Heart rate, but not mean arterial pressure, was significantly lower in the DEX group than in the REMI group, at 1 min after intubation and from 30 min after the start of the surgery until anesthesia recovery. Sevoflurane concentration and dosage were significantly lower in the DEX group than in the REMI group.ConclusionDuring RFA for HCC, low-dose dexmedetomidine reduced the heart rate and need for inhalational anesthetics, without exacerbating postoperative discomfort or liver dysfunction. Although it did not exhibit outstanding advantages over remifentanil in terms of pain management, dexmedetomidine could be a safe alternative adjuvant for RFA under sevoflurane anesthesia.Trial registrationChinese Clinical Trial Registry, ChiCTR-OPC-15006613. Registered on 16 June 2015.
Highlights
Remifentanil is widely used for ultrasound-guided percutaneous radiofrequency ablation (RFA) of small hepatocellular carcinoma (HCC)
Percutaneous RFA can be performed under sedation, local anesthesia, or general anesthesia
The baseline characteristics were well balanced between the two groups in terms of demographics and preoperative liver function (Table 2)
Summary
Remifentanil is widely used for ultrasound-guided percutaneous radiofrequency ablation (RFA) of small hepatocellular carcinoma (HCC). We determined whether dexmedetomidine could be an alternative to remifentanil for RFA of HCC under general anesthesia with sevoflurane. Ultrasound-guided percutaneous radiofrequency ablation (RFA) is one of the most effective treatments for small hepatocellular carcinomas (HCCs) [1, 2]. Owing to its superior tumor control, high survival rates, minimally invasive nature, and ease of use, RFA has become the first-line treatment for small HCCs, especially in patients who are not eligible for surgical resection or liver transplantation [7, 8]. Some patients experience severe pain and anxiety during RFA under local anesthesia, which results in lower patient satisfaction and insufficient tumor ablation [9]. General anesthesia provides better pain control, better tolerance, and lower local recurrence rates [10]
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