Rescue paravertebral block for severe pain after microwave ablation of hepatocellular carcinoma: A case report

We present a case of severe, unexpected pain following microwave ablation for recurrent hepatocellular carcinoma, refractory to routine multimodal analgesia, which was successfully relieved by right-sided thoracic paravertebral block. The patient, with a history of opioid tolerance and respiratory disease, had undergone two previous microwave ablations for recurrent tumor in the same location with minimal pain. On this occasion, he experienced severe post-ablation pain unresponsive to intravenous opioids, resulting in worsening respiratory failure. Faced with the challenge of providing effective analgesia without further compromising respiratory function, we successfully performed right-sided T7 and T8 paravertebral blocks as a rescue analgesic technique. This rapidly alleviated pain and improved respiratory status, avoiding the need for reintubation. This case highlights the highly variable and unpredictable nature of pain after microwave ablation of liver lesions and demonstrates that thoracic paravertebral block can be an effective rescue analgesic technique when conventional multimodal analgesia fails.