[Renal denervation for resistant hypertension without general anesthesia: advantage of a MEOPA morphine protocol. Preliminary experience]

Abstract

Renal denervation using the technique of radiofrequency is used only recently for the treatment of resistant hypertension. Normally, it is done under general anesthesia because the ablation point technique is painful. We suggest an alternative to general anesthesia comprising an association of morphin 0.1mg/kg IV to MEOPA (gas combining oxygen and azot protoxyd) delivered through an oxygen mask. Our series includes 12 consecutive patients treated between October 2011 and June 2013, the first five patients (group 1) have received only an hydroxizin and morphin sedation. Every five have felt the ablation painful, in two cases bearable pain (EVA<5), in three cases intense (EVA>5) pain leading to increasing doses of morphin, (total dose of 0.25mg/kg in two cases, 0.17mg in one case). For the seven following patients, a protocol including hydroxyzin, morphin and MEOPA given through a mask has been set up. Only one patient has felt a mild pain (EVA 5) leading to an increasing dose of morphin (total dose 0.17mg/kg). None of the six other patients has felt any pain during the procedure. The average dose of morphin is 0.17mg/kg in group 1, 0.11mg/kg in group 2. This is a preliminary study; if confirmed, it will allow a lot of hospitals without on-site possibilities of general anesthesia, to realize such procedures.

Conclusion: regarding pain, the procedure of renal ablation was well tolerated for six among seven patients receiving the association MEOPA and IV morphin. In contrast, in the five patients treated only with IV morphin, we observed a less good tolerance to pain and the need to increase the doses of IV morphin.

Keywords: Ablation par radiofréquence; Analgesia; Analgésie; Analgésie multimodale; Anesthésie générale; Dénervation rénale; General anesthesia; HTA réfractaire; MEOPA; Morphin; Morphin saving; Morphine; Mutimodal analgesia; Procédure courte; Radiofrequency ablation; Renal denervation; Resistant hypertension; Short procedure; Épargne morphinique.