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. 2020 Apr;45(4):255-259.
doi: 10.1136/rapm-2019-100686. Epub 2020 Feb 16.

Thoracoscopic lung biopsy under regional anesthesia for interstitial lung disease

Chitaru Kurihara  1 , Brian Tolly  2 , Andre DeWolf  2 , Antoun Nader  2 , Samuel Kim  3 , David D Odell  3 , Angela C Argento  4 , G R Scott Budinger  4 , Ankit Bharat  3
Affiliations

Thoracoscopic lung biopsy under regional anesthesia for interstitial lung disease

Chitaru Kurihara et al. Reg Anesth Pain Med. 2020 Apr.

Abstract

Background: Interstitial lung disease (ILD) management guidelines support lung biopsy-guided therapy. However, the high mortality associated with thoracoscopic lung biopsy using general anesthesia (GA) in patients with ILD has deterred physicians from offering this procedure and adopt a diagnostic approach based on high-resolution CT. Here we report that thoracoscopy under regional anesthesia could be a safer alternative for lung biopsy and effectively guide ILD treatment.

Methods: This was a single-center retrospective review of prospectively maintained database and consisted of patients who underwent thoracoscopic lung biopsy between March 2016 and March 2018. Patients were divided into two groups: (A) GA, and (B) regional anesthesia using monitored anesthesia care (MAC) and thoracic epidural anesthesia (TEA).

Results: During the study period, 44 patients underwent thoracoscopic lung biopsy. Of these, 15 underwent MAC/TEA. There were no significant differences between the two groups with regard to pulmonary function test and clinicodemographic profile. However, operative time and hospital stay were shorter in MAC/TEA group (32.5±18.5 min vs 50.8±18.4; p=0.004, 1.0±1.3 days vs 10.0±34.7 days; p<0.001, respectively). Eight patients in the GA group, but none in the MAC/TEA group, experienced worsening of ILD after lung biopsy (p=0.03). Additionally, one patient in the GA group died due to acute ILD worsening. No cases of MAC/TEA group had to be converted to GA. In all cases a pathological diagnosis could be made.

Conclusions: Thoracoscopy using regional anesthesia might be a safer alternative to lung biopsy in patients with ILD.

Keywords: acute pain; alternative therapies; intravenous regional anesthesia.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Kaplan-Meier curve showing interstitial lung disease (ILD) exacerbation-free survival in patients after lung biopsy with monitored anesthesia care (MAC) plus thoracic epidural anesthesia (TEA) (broken red line; n=15) and with general anesthesia (solid blue line; n=29).
See this image and copyright information in PMC

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