Applications and Advancements of Regional Anesthesia in Interventional Radiology

Monday, March 6, 2023

5:20 PM – 5:25 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Ishwarya Sivakumar, BS (she/her/hers)

Medical Student
Johns Hopkins University

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Tushar Garg, MD (he/him/his)

Postdoctoral Research Fellow
Johns Hopkins University School of Medicine
Robert M. Weinstein, BS

Medical Student
The Johns Hopkins University
Anna J. Gong, BA

Medical Student
Johns Hopkins University
Aryaman Gupta, n/a

Medical Student
Johns Hopkins University
PG

Prateek C. Gowda, BS

Medical Student
Johns Hopkins University
Adham Khalil, MD

Postdoctoral Research Fellow
Johns Hopkins University, Department of Radiology
CW

Clifford Weiss, MD, FSIR, FCIRSE

Professor of Radiology and Biomedical Engineering
Johns Hopkins Univeristy School of Medicine

Disclosure(s):

Ishwarya Sivakumar, BS: No financial relationships to disclose

Prateek C. Gowda, BS: No financial relationships to disclose

Clifford Weiss, MD, FSIR, FCIRSE: Boston Scientific: Consultant (Ongoing), Intellectual Property Rights (Ongoing), Research Grant Recipient (Ongoing); Guerbet: Research Grant Recipient (Ongoing); Medtronic: Consultant (Ongoing), Research Grant Recipient (Ongoing); Siemens Healthineers: Consultant (Ongoing), Research Grant Recipient (Ongoing)

Learning Objectives:

To describe the clinical and experimental uses of regional anesthesia in interventional radiology.

Background:

As the complexity of IR procedures increases, there is a demand for periprocedural pain management. Regional anesthesia or “nerve blocks” involve injection of local anesthetics near sensory nerves to temporarily interrupt nociceptive impulses. Nerve blocks are an increasingly popular option for periprocedural analgesia in IR because they decrease post procedural hospitalization, the side effects and risks of opioids, and the need for general anesthesia.

Clinical Findings/Procedure Details:

Regional anesthesia can be performed as a single-injection or continuous infusion via perineural catheter. Commonly used agents are lidocaine, bupivacaine, ropivacaine, and mepivacaine. Nerve blocks are usually performed under image guidance to reduce complications and the volume of local anesthetics needed for success. We will discuss the common techniques and applications of nerve blocks in IR as detailed in Table 1.

Regional anesthesia techniques in IR are still developing. For example, while several IR procedures target the liver, there have traditionally been few peri-procedural pain control options beyond systemic medications. A new technique has been developed to deliver a hepatic hilar nerve block with 0.25% bupivacaine by image guidance near the main portal vein {1}. Hepatic hilar nerve blocks are shown to effectively lower pain during chemoembolization and liver ablation, while decreasing opioid use and complications {2}.

Conclusion and/or Teaching Points:

Regional anesthesia reduces risks of perioperative complications and adverse events, so they should be incorporated into an interventional radiologist’s clinical repertoire.