Optimization of pleural multisite anesthetic technique during CT-guide microwave ablation of peripheral lung malignancy for improving treatment tolerance

Figures & data

Table 1. Patients demographic.

	No. of lung pleural anesthesia
Demographic	All (n = 243)	Pleural puncture point anesthesia (n = 124)	Subpleural anesthesia based on thermal radiation (n = 119)	p Value
Age (years)	72.8+−10.3	73.6+ −10.1	70.6+ −10.5	.968
Female	119 (49.0)	60 (48.4)	59 (49.6)	.874
Histological types				.465
Primary lung cancer	45 (18.5)	24 (19.4)	21 (17.6)
Metastases to lung	198 (81.5)	100 (80.6)	98 (82.4)
History of cancer pain	23 (9.5)	13 (10.5)	10 (8.4)	.569
Emphysema	90 (37.0)	48 (38.7)	42 (35.3)	.636

Table 2. Lesion characteristics for patients.

	No. of lung pleural anesthesia
Lesion characteristic	Pleural puncture point anesthesia (n = 124)	Subpleural anesthesia based on thermal radiation (n = 119)	p Value
Lung lesion size (mm)	18.6+ −10.3	19.8+ −11.2	.436
Skin-to-pleura distance (mm)	43.2+ −23.6	45.8+ −22.8	.602
Pleura-to-lesion distance (mm)			.588
(−)	52 (41.9)	55 (46.2)
(1–5)	38 (30.6)	40 (33.6)
(6–10)	34 (27.4)	24 (20.2)
Location			.201
Right upper lobe	42 (33.9)	36 (30.3)
Right lower lobe	19 (15.3)	20 (16.8)
Left upper lobe	31 (25.0)	34 (28.6)
Left lower lobe	21 (16.9)	21 (17.6)
Middle lobe	11 (8.8)	9 (7.6)
Length of interface with pleura (mm)			.369
(–)	72 (58.1)	64 (53.8)
(1–10)	28 (22.6)	29 (24.4)
(11–20)	20 (16.1)	15 (12.6)
(>20)	4 (3.2)	11 (9.2)
Local pleural thickening adhesion	59 (47.6)	62 (58.1)	.426

Table 3. Multivariable logistic regression predicting likelihood of moderate and severe pain.

	Multivariate analysis
Variable	HR (95% CI)	p Value
Methods of local anesthesia	2.347 (1.557, 4.816)	.001
Age (years)	0.989 (0.946, 1.027)	.779
Sex	0.932 (0.705, 1.326)	.865
Emphysema	0.627 (0.313, 1.326)	.338
History of cancer pain	1.106 (0.938, 1.279)	.473
Pleura-to-lesion distance (cm)	0.248 (0.126, 0.392)	.02
Size (cm)	1.024 (0.438, 2.853)	.015
Lesion location	0.852 (0.424, 1.294)	.368
Histological types	0.979 (0.925, 1.118)	.594
Length of interface with pleura (cm)	0.905 (0.728, 1.141)	.224

The significance of bold values was p value < 0.01.

Table 4. Multivariable logistic regression predicting likelihood of intravenous pain medications usage.

	Multivariate analysis
Variable	HR (95% CI)	p Value
Methods of local anesthesia	2.402 (1.142, 4.902)	.001
Age (years)	0.992 (0.973, 1.026)	.779
Sex	0.928 (0.481, 1.828)	.826
Emphysema	0.671 (0.350, 1.296)	.246
History of cancer pain	1.104 (0.926, 1.308)	.295
Pleura-to-lesion distance (cm)	2.236 (1.016, 4.002)	.026
Size (cm)	1.257 (0.835, 3.745)	.352
Lesion location	0.922 (0.716, 1.148)	.581
Histological types	0.892 (0.786, 1.128)	.471
Length of interface with pleura (cm)	0.979 (0.945, 1.148)	.582

The significance of bold values was p value < 0.01.

Table 5. Multivariable logistic regression predicting likelihood of local tumor progression.

	Multivariate analysis
Variable	HR (95% CI)	p Value
Methods of local anesthesia	2.106 (1.004, 4.205)	.038
Age (years)	0.966 (0.923, 1.048)	.901
Sex	0.835 (0.441, 1.775)	.867
Emphysema	0.602 (0.315, 1.288)	.369
Pleura-to-lesion distance (cm)	0.248 (0.152, 0.626)	.001
Size (cm)	2.023 (1.267, 3.542)	.008
Lesion location	0.898 (0.748, 1.206)	.602
Histological types	0.766 (0.564, 1.477)	.513
Length of interface with pleura (cm)	0.724 (0.731, 1.514)	.663

The significance of bold values was p value < 0.01.

Figure 1. The puncture path of the needle into the subpleural site during local anesthesia.

Figure 2. The puncture path of microwave ablation needle percutaneous into lung tumor.