Nonintubated thoracoscopic lobectomy for lung cancer using epidural anesthesia and intercostal blockade
Journal
Medicine (United States)
Journal Volume
94
Journal Issue
13
Date Issued
2015
Author(s)
Abstract
Intubated general anesthesia with single-lung ventilation has been considered mandatory for thoracoscopic lobectomy for nonsmall cell lung cancer. Few reports of thoracoscopic lobectomy without tracheal intubation are published, using either thoracic epidural anesthesia (TEA) or intercostal blockade. The comparisons of perioperative outcomes of nonintubated thoracoscopic lobectomy using epidural anesthesia and intercostal blockade are not reported previously. From September 2009 to August 2014, a total of 238 patients with lung cancer who underwent nonintubated thoracoscopic lobectomy were recruited from our prospectively maintained database of all patientsundergoing nonintubated thoracoscopic surgery using TEA or intercostal blockade. A multiple regression analysis, adjusting for preoperative variables, was performed to compare the perioperative outcomes of the 2 anesthesia methods. Overall, 130 patients underwent nonintubated thoracoscopic lobectomy using epidural anesthesia whereas 108 had intercostal blockade. The 2 groups were similar in demographic data, except for sex, preoperative lung function, physical status classification, and history of smoking. After adjustment for the preoperative variables, nonintubated thoracoscopic lobectomy using intercostal blockade was associated with shorter durations of anesthetic induction and surgery (P<0.001). Furthermore, hemodynamics were more stable with less use of vasoactive drugs (odds ratio: 0.53; 95% confidence interval [CI], 0.27 to 1.04; P=0.064) and less blood loss (mean difference:-55.2mL; 95% CI,-93 to-17.3; P=0.004). Postoperatively, the 2 groups had comparable incidences of complications. Patients in the intercostal blockade group had a shorter average duration of chest tube drainage (P=0.064) but a similar average length of hospital stay (P=0.569). Conversion to tracheal intubation was required in 13 patients (5.5%), and no in-hospital mortality occurred in either group. Nonintubated thoracoscopic lobectomy using either epidural anesthesia or intercostal blockade is feasible and safe. Intercostal blockade is a simpler alternative to epidural anesthesia for nonintubated thoracoscopic lobectomy in selected patients with lung cancer. ? 2015 Wolters Kluwer Health, Inc.
SDGs
Other Subjects
bupivacaine; carbon dioxide; fentanyl; lidocaine; morphine; oxyhemoglobin; vasoactive agent; adult; aged; anesthesia induction; arterial carbon dioxide tension; Article; cancer mortality; cancer surgery; cohort analysis; continuous epidural anesthesia; continuous infusion; controlled study; coughing; endoscopic surgery; endotracheal intubation; epidural catheter; female; heart arrhythmia; hospitalization; human; hypotension; incidence; intercostal nerve block; lung cancer; lung function; lung lobectomy; lymph node dissection; major clinical study; male; mediastinum lymph node; middle aged; nonintubated thoracoscopic lobectomy; outcome assessment; patient controlled analgesia; pneumonia; postoperative analgesia; postoperative hemorrhage; postoperative pain; postoperative vomiting; priority journal; pulse oximetry; retrospective study; subcutaneous emphysema; thoracoscopy; thorax drainage; thorax epidural anesthesia; treatment refusal; very elderly; video assisted thoracoscopic surgery; adverse effects; Carcinoma, Non-Small-Cell Lung; epidural anesthesia; hemodynamics; length of stay; Lung Neoplasms; Postoperative Complications; procedures; thoracoscopy; time; Aged; Anesthesia, Epidural; Carcinoma, Non-Small-Cell Lung; Female; Hemodynamics; Humans; Length of Stay; Lung Neoplasms; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Thoracoscopy; Time Factors
Publisher
Lippincott Williams and Wilkins
Type
journal article