Erector spine plane block as single loco-regional anesthesia in non-intubated video-assisted thoracic surgery for unfit patients: a case-match study

In the present study, we analyzed the safety and efficacy of non-intubated video-assisted thoracoscopy (NI-VATS) for the diagnosis and palliation of malignant pleural effusion in the elderly population using erector-spinae plane block (ESPB) as single loco-regional anesthesia. From January 2016 to December 2020 a consecutive series of 158 patients who underwent surgery for malignant pleural effusion was analyzed. Of these, 20 patients were operated using ESPB NI-VATS, while 138 were operated under general anesthesia (GA). After propensity score matching, the NI-VATS population was older (81 vs. 76 years p 0.006), and had more severe pre-existing comorbidities, evaluated using Charlson Comorbidity Index (p = 0.029) and ASA score (p < 0.001). GA and NI-VATS patients did not differ in terms of postoperative opioid consumption, complication rate and postoperative hospitalization. Both short- and long-term efficacy of talc poudrage was equal in the two populations. The overall length of stay in the operative room was significantly shorter for the NI-VATS than for the GA-VATS group (67.5 vs. 105 min, p < 0.001), and operative time significantly differed in the two groups (35 vs. 47.5 min, respectively, p < 0.001). ESPB NI-VATS can be a safe and effective option for the diagnosis and palliation of malignant pleural effusion for elderly and frail patients.

Automated summary

This study analyzed the safety and efficacy of non-intubated video-assisted thoracoscopy (NI-VATS) with erector-spinae plane block (ESPB) as anesthesia for the diagnosis and palliation of malignant pleural effusion in elderly patients. A total of 158 patients who underwent surgery for malignant pleural effusion were included in the analysis. After propensity score matching, it was found that NI-VATS patients were older and had more severe pre-existing comorbidities compared to those who underwent surgery under general anesthesia (GA). However, there were no differences in postoperative opioid consumption, complication rate, and postoperative hospitalization between the two groups. The overall length of stay in the operative room and operative time were significantly shorter in the NI-VATS group. ESPB NI-VATS is a safe and effective option for the diagnosis and palliation of malignant pleural effusion in elderly and frail patients.