Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2023.06.003
Brazilian Journal of Anesthesiology
Letter to the Editor

Erector spinae plane block for urgent pleuroscopy: a possible change in anesthetic approach for high-risk patients

Ruggero Massimo Corso, Claudia Ravaglia, Nicoletta Fossati, Dusica Stamenkovic

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Abstract

Dear Editor,

Pleuroscopy, also known as medical thoracoscopy, is a commonly performed diagnostic and therapeutic procedure regarded as the cornerstone of pleural disease management. The anesthetic management of these patients is not standardized, ranging from sedation with local anesthesia to general anesthesia with definitive airway control. Even if a considerable proportion of pleuroscopy patients have multiple comorbidities besides respiratory disease, pleuroscopy is usually performed in a bronchoscopy suite on an outpatient basis. The challenges in managing pleuroscopy cases include lateral decubitus positioning, iatrogenic pneumothorax, pendelluft ventilation, and sedation effects, which may result in significant respiratory compromise and potentially life-threatening complications. A trocar (6.5 to 11.5 mm) and a video-thoracoscope with a 0° optical telescope are inserted 1 to 2 cm on the midaxillary line between the fourth and seventh intercostal spaces; the procedure is painful, especially in the case of talc insufflation or biopsies, making perioperative pain control one of the fundamental goals of its anesthetic management.

References

1. Wan YY, Zhai CC, Lin XS, et al. Safety and complications of medical thoracoscopy in the management of pleural diseases. BMC Pulm Med. 2019;19:125.

2. Forero M, Adhikary SD, Lopez H, et al. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41:621−7.

3. Feray S, Lubach J, Joshi GP, et al. PROSPECT guidelines for video-assisted thoracoscopic surgery: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2022;77:311−25.

4. Koo CH, Lee HT, Na HS, et al. Efficacy of erector spinae plane block for analgesia in thoracic surgery: a systematic R.M. Corso, C. Ravaglia, N. Fossati et al. review and meta-analysis. J Cardiothorac Vasc Anesth. 2022;36:1387−95.

5. Natoli S. The multiple faces of ketamine in anaesthesia and analgesia. Drugs Context. 2021;23. 2020-12-8.

6. Zheng H, Hu XF, Jiang GN, et al. Nonintubated-awake anesthesia for uniportal video-assisted thoracic surgery procedures. Thorac Surg Clin. 2017;27:399−406.

7. Agnoletti V, Gurioli C, Piraccini E, et al. Efficacy and safety of thoracic paravertebral block for medical thoracoscopy. Br J Anaesth. 2011;106:916−7.

8. Jokinen M. The pharmacokinetics of ropivacaine in hepatic and renal insufficiency. Best Pract Res Clin Anaesthesiol. 2005; 19:269−74.

9. Jokinen MJ, Neuvonen PJ, Lindgren L, et al. Pharmacokinetics of ropivacaine in patients with chronic end-stage liver disease. Anesthesiology. 2007;106:43−55.

10. Sharp A, Mudda G, Braehler MR, et al. Erector spinae plane block: a novel anesthetic approach for pleuroscopy. J Bronchology Interv Pulmonol. 2022;29:109−14.

11. Jiao B, Chen H, Chen M, et al. Opioid-sparing effects of ultrasound-guided erector spinae plane block for adult patients undergoing surgery: a systematic review and meta-analysis. Pain Pract. 2022;22:391−404.

12. Shiraishi Zapata C. I-gel airway for advanced uses: a case of successful utilization of this second-generation supraglottic airway device for controlled ventilation during general anesthesia in lateral decubitus position. Minerva Anestesiol. 2017;83:219−20.

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