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Case Reports
. 2024 Jul 8;166(1):284.
doi: 10.1007/s00701-024-06173-0.

Bupivacaine pleural effusion mimicking a hemothorax after a thoracoscopic microdiscectomy with epidural anesthesia

Maarten Te Dorsthorst-Maas  1   2 , Yvonne L J Vissers  3 , Nico M Grupa  4 , Debbie S Deben  5 , Toon F M Boselie  6   7
Affiliations
Case Reports

Bupivacaine pleural effusion mimicking a hemothorax after a thoracoscopic microdiscectomy with epidural anesthesia

Maarten Te Dorsthorst-Maas et al. Acta Neurochir (Wien). .

Abstract

Purpose: Post-operative pain after video-assisted thoracoscopic surgery is often treated using thoracic epidural analgesics or thoracic paravertebral analgesics. This article describes a case where a thoracic disc herniation is treated with a thoracoscopic microdiscectomy with post-operative thoracic epidural analgesics. The patient developed a bupivacaine pleural effusion which mimicked a hemothorax on computed tomography (CT).

Methods: The presence of bupivacaine in the pleural effusion was confirmed using a high performance liquid chromatography method.

Results: The patient underwent a re-exploration to relieve the pleural effusion. The patient showed a long-term recovery similar to what can be expected from an uncomplicated thoracoscopic microdiscectomy.

Conclusion: A pleural effusion may occur when thoracic epidural analgesics are used in patents with a corridor between the pleural cavity and epidural space.

Keywords: Bupivacaine; Epidural anesthesia; Hemothorax; Thoracic disc herniation; Thoracoscopic microdiscectomy.

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References

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