Conscious Sedation during Percutaneous Image-guided Palliative Radiofrequency Ablation of Painful Bone Metastases: A Case Series

Presentation Format: Oral presentation.

Purpose or Learning Objective: Percutaneous thermal ablation of bone metastases is typically performed under general anesthetic (GA). We describe the use of conscious sedation during percutaneous image-guided thermal ablation of painful bone metastases.

Methods or Background: A retrospective review was performed of 33 thermal ablation procedures performed on 21 patients between 2018 and 2020. Data on patient demographics, primary tumor, metastasis location, radiotherapy treatment, indications for ablation, technical ablation success, sedation requirements, and subsequent patient outcomes were recorded. Data on all complications were identified.

Results or Findings: A total of 33 ablation procedures were performed in 21 patients: 13 men (mean age: 67 years; range: 41–87 years) and 8 women (mean age: 54 years; range: 42–76 years) were included. Primary tumors included breast cancer, cholangiocarcinoma, gastrointestinal adenocarcinoma, small cell lung cancer, non–small cell lung cancer, lymphoma, melanoma, myeloma, prostate cancer, renal cell carcinoma, and urothelial cell carcinoma. Ablation procedures were performed within the thoracic spine (n = 8), lumbar spine (n = 18), and pelvis (n = 7). In 16 cases, palliative thermal ablation of bony metastases was performed under conscious sedation with a mean administered dose of 148 μg fentanyl and 6 mg midazolam. The compared control cohort included 15 cases of thermal ablation performed under GA. Procedures performed under conscious sedation were ~ 16% faster (133 minutes; range: 90–180 minutes versus 158 minutes; range: 100–200 minutes). Conscious sedation was well tolerated in all cases, and no significant complications were reported in either the conscious sedation or GA groups. The mean survival interval following the procedure was 320 days (range: 36–911 days) observed in 10 patients. The remaining 12 patients died during follow-up after ablation with a mean survival time of 136 days (range: 29–448 days).

Conclusion: Conscious sedation is a safe and effective option for controlling patient pain during palliative thermal ablation of painful bone metastases. Advantages of this technique include faster procedure times, swifter recovery, and permitting intraprocedural neurologic monitoring when compared with GA. No complications of this technique were identified in our series.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
03 June 2021