P199 The role of multi-level intercostal nerve block in local anaesthetic thoracoscopy (LAT)

Ajmal, Syed; Walker, Duncan R.; Johnstone, S; Caruana, Emmanuel; Tufail, Muhammad; Panchal, RK

doi:10.1136/thorax-2021-btsabstracts.308

Cited by 3 publications

(4 citation statements)

References 2 publications

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“…Although pleuroscopy commonly involves a single incision and avoids prolonged postoperative chest tube placement, pain has still been reported to be the most frequent complication postoperatively [41] The role of multilevel thoracic intercostal nerve block performed by the proceduralist has been considered with reduction in both postoperative pain and length of stay [42 ▪▪ ]. There has also been recent interest in the role of regional nerve blocks performed by anesthesiologists to reduce both intraoperative and postoperative pain as well as reduce the amount of sedatives and narcotics used during the procedure.…”

Section: Medical Pleuroscopymentioning

confidence: 99%

Anesthetic considerations in interventional pulmonology

Sikachi,

Mishra,

Anders

2023

Current Opinion in Pulmonary Medicine

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Purpose of review In this review, we highlight the important anesthetic consideration that relate to interventional bronchoscopic procedures for the management of central airway obstruction due to anterior mediastinal masses, endoluminal endobronchial obstruction, peripheral bronchoscopy for diagnosis and treatment of lung nodules, bronchoscopic lung volume reduction and medical pleuroscopy for diagnosis and management of pleural diseases. Recent findings The advent of the field of Interventional Pulmonology has allowed for minimally invasive options for patients with a wide range of lung diseases which at times have replaced more invasive surgical procedures. Ongoing research has shed light on advancement in anesthetic techniques and management strategies that have increased the safety during peri-operative management during these complex procedures. Current evidence focusing on the anesthetic techniques is presented here. Summary The field of Interventional Pulmonology requires a tailored anesthetic approach. Recent advancements and ongoing research have focused on expanding the partnership between the anesthesiologist and interventional pulmonologists which has led to improved outcomes for patients undergoing these procedures.

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Section: Medical Pleuroscopymentioning

confidence: 99%

Anesthetic considerations in interventional pulmonology

Sikachi,

Mishra,

Anders

2023

Current Opinion in Pulmonary Medicine

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“…Despite the non-inferiority trial of Grendelmeier et al [ 32 ] showing that propofol led to a higher incidence of hypoxaemia and hypotension when compared to midazolam, Tschopp et al demonstrated that bispectral index guided propofol was a safe method of sedation and facilitated early discharge following the procedure [ 33 ]. Other methods of analgesia, including intercostal nerve block, erector spinae plane block or intrapleural lidocaine via semi-rigid thoracoscopes, have been utilised [ 34 , 35 , 36 ]. There is no standardisation for any sedation method.…”

Section: Technique Sedation and Complicationsmentioning

confidence: 99%

“…Refs. [ 35 , 36 , 37 , 38 ] Furthermore, the semi-rigid thoracoscope has a similar safety profile to the fully rigid one [ 37 , 38 , 39 , 40 , 41 ]. Table S1 summarises the salient points in some of the above described studies.…”

Section: Technique Sedation and Complicationsmentioning

confidence: 99%

Local Anaesthetic Thoracoscopy for Pleural Effusion—A Narrative Review

Jackson

Panchal

et al. 2022

Healthcare

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The incidence of pleural disease is increasing, and interventions are crucial in this subspecialist area of respiratory medicine. One of the cornerstones of pleural effusion investigation and management is medical, which is also known as local anaesthetic thoracoscopy. This allows fluid drainage, biopsy for diagnosis and preventative measures for further fluid potential build-up. This article summarises the evidence around this procedure through a narrative review of the available evidence.

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“…There has been some preliminary work on improving pre-procedural analgesia in MT, and this builds on the potential value of ESP being used in MT. Midpoint transverse process to pleura blocks have been described [ 11 ] as well as multi-level intercostal nerve blocks [ 12 ] and paravertebral blocks [ 13 ]. Intracavitary anesthesia has also been trialed via a small single centre pilot study, with no difference in pain scores between the two groups [ 14 ].…”

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confidence: 99%

Erector spinae plane blocks for day-case medical thoracoscopy: a pilot clinical study

McPherson

Halvey

Aujayeb

2022

Pleura and Peritoneum

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Objectives Erector spinae plane (ESP) blocks are a regional anaesthetic technique used for pain relief in thoracic procedures. Our centre has recently begun using ESP blocks pre-medical thoracoscopy for analgesia. Methods Nine patients undergoing MT from September 2021 to February 2022 were included. Opioid use and depth of required sedation was recorded. Pre and post pain scores and at home were recorded by interview and review of charts. A functional pain questionnaire was administered via telephone. Results Average greatest depth of sedation using propofol was 1.92 (standard error of mean [SEM] 0.27), with remifentanil 2.52 (SEM 0.46). 78% required oral analgesia on day 0 post discharge. 55% required oral analgesia on post-op day 1. Patients used an average of 3.33 mg oral morphine (SEM 2.35) in hospital, and 3 mg (SEM 2) on post-op day 1. Periprocedural pain scores were 0.66 (SEM 0.27). Pain scores in recovery were 1.56 (SEM 0.76). Pain scores 3–12 h post discharge were 3.56 (SEM 0.7), while pain scores on post-op day 1 were significantly higher at 5.56 (SEM 0.90) (Figure 1). Functional pain scoring showed patients doing activities of daily living well with a good ability to breathe and cough. All felt that their pain was well controlled on the day of the procedure and at home. No complications were reported. Conclusions ESP blocks provide good analgesia. Pain scores showed significant analgesic effect lasting several hours. The project showed pain outcomes and patient acceptability were good for the use of regional anaesthesia.

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P199 The role of multi-level intercostal nerve block in local anaesthetic thoracoscopy (LAT)

Cited by 3 publications

References 2 publications

Anesthetic considerations in interventional pulmonology

Anesthetic considerations in interventional pulmonology

Local Anaesthetic Thoracoscopy for Pleural Effusion—A Narrative Review

Erector spinae plane blocks for day-case medical thoracoscopy: a pilot clinical study

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