The effects and outcomes of regional block anesthesia in non-intubated thoracoscopy
M. Ueoka*a (Dr), R. Garcia Tomea (Dr), N. Naimb (Dr), R. Movahedib (Dr), P. Chiab (Dr), S. Oha (Dr), C. Oberga (Dr), T. Hea (Dr), I. Susantoa (Dr), R. Ronaghia (Dr)
a University of California, Los Angeles, Department of Pulmonary and Critical Care, Los Angeles, UNITED STATES ; b University of California, Los Angeles, Department of Anesthesiology, Los Angeles, UNITED STATES
Video assisted thoracic surgery (VATS) and thoracoscopy can both treat a variety of pleural diseases. VATS generally requires general anesthesia, and mortality has been reported to be as high as 21.7% in non-elective cases. Thoracoscopy can be performed under moderate sedation without intubation. We aimed to look at the effects of regional anesthesia in thoracoscopy.
Patients who received pre-operative regional anesthesia with thoracic epidural infusions from May-June 2022 were evaluated. Patients who declined regional anesthesia during the same time period were reviewed for comparison. All patients underwent thoracoscopy; the amount and types of sedation and analgesia intra- and post-operatively were reviewed. Data was collected and analyzed using SPSS analytical software.
A total of 24 patients were reviewed (n=24). All patients underwent thoracoscopy for various pleural diseases; 12 patients received regional anesthesia and 12 did not. Intra-op lidocaine requirements were significantly lower in the regional anesthesia group, 20.5 vs. 27.4 mg (p=0.03). Intra-op propofol and fentanyl requirements were also significantly lower, 91.2 ± 18.2 vs. 185.2 ± 22.1 mg (p=0.0002) and 42.3 ± 12.3 vs. 95.4 ± 14.2 mcg, (p= 0.003), respectively. Midazolam use was similar in both groups. The need for vasopressor support with phenylephrine was also significantly lower in the regional anesthesia group, 101.4 ± 22.2 vs. 134.5 ± 56.2 mcg, (p=0.02). Post-operatively, oxycodone use was also significantly lower, 20.5 ± 7.3 vs. 26.3 ± 5.2 mg, (p=0.0001).
We present one of the largest data sets investigating regional anesthesia in thoracoscopy. Our data shows significantly less need for sedation and anesthesia intra-op in those who received regional anesthsia, as well as decreased post-operative pain medication requirement. Thoracoscopy offers a potentially safer alternative to VATS given reduced sedation and analgesic needs and may be particularly helpful in patients who may not be fit for general anesthesia.
Disclosure of funding source(s): none