Background and Aims Percutaneous CT-guided renal cryoablation is a safe and effective alternative to surgery for small renal cancer, feasible for fragile and elderly patients since it’s minimally invasive and ‘nephron-sparing’; it reduces pain, morbidity, length of hospitalization⁽¹⁾. It consists in ‘freezing’ the tumor through multiple Argon-gas probes, placed in the correct position under CT-scan guide. Absence of pain, required for patient cooperation in maintaining immobility and arm abduction during the whole procedure inside the CT-scan, is a challenge for the anesthesiologist.

Thoracic ESP block is performed by injection of local anesthetic in the fascial plane deeper than the ESP muscle, at the tip of the transverse process of the vertebra (T10); it provides visceral and somatic analgesia up to 6 vertebral levels downstream of the injection point⁽²⁾.

Methods Two patients (males, 68 and 83 yo) were scheduled for renal cryoablation; after a mild sedation with iv midazolam (2 mg) and sufentanyl (2–5 mcg), we performed an US-guided T10 ESP-block with a mixture of 0.25% levobupivacaine and dexamethasone 4mg. Before entering the CT-scan, we also performed an US-guided bilateral infraclavicular block (0.1%levobupivacaine 20 ml) to allow arm positioning.

Results The procedures lasted about 180 minutes; no complication occurred, patients kept calm and cooperative during the whole time, with stable vital signs. NRS score at the end of procedure and during the following 24 hours was 0. Patients were both discharged at day 1.

Conclusions The ‘total regional’ analgesia context has shown to be safe, effective and satisfying even in a non operative room setting.