To analyse the effect of topicalization of Glissonian capsule with 2% Lignocaine on anaesthetic drug doses for Monitored anaesthesia care in Percutaneous radiofrequency ablation of Liver.

Percutaneous radiofrequency ablation (PRFA) of solid tumors is a minimally invasive procedure to treat primary and/or metastatic solid tumors via thermal tissue destruction as a result of targeted thermal energy deposition and coagulative necrosis. Glisson’s capsule, the fibrous covering of the liver, is innervated by branches of the lower intercostal nerves which carries sensory pathway for pain. The RFA of a subcapsular tumor causes generation of heat and gases due to burning of tumor tissue. This in turn stimulates the sensory nerve endings at the Glisson’s capsule causing severe pain. This also make the ablation difficult as patient moves due to pain and may thus displace the ablation needle.

Most common method of sedation and analgesia for such procedures include: intravenous opioids, dexmedetomidine infusion, inj. ketamine and propofol. Mixture of these drugs in different doses helps the radiologist to complete the procedure with calm patient when the lesion is in liver parenchyma. For subcapsular region, the situation is different. To combat severe pain due to liver capsule irritation, high doses of these drugs are given which in turn also causes respiratory depression and obstructed airway further complicating the situation. Most commonly used drugs for such scenario are propofol and ketamine.

     In view of these issues we propose a hypothesis that topicalization of Glissonian capsule with 2% lignocaine will provide adequate analgesia and reduces the dosage of anaesthetic drug.