Use of Regional Anesthesia in Minimally Invasive Thoracic Surgery: A Multi-Center Retrospective Review
Jielin Yu1, Mario Katigbak2, Stefan Kachala2
1University of Connecticut, West Hartford, Connecticut, United States, 2Department of Surgery, Hartford Healthcare, Hartford, Connecticut, United States
1. Objective
To evaluate the effect of regional anesthesia on short-term outcomes in minimally invasive thoracic surgery
2. Design
Retrospective cohort study involving all patients undergoing minimally invasive thoracic surgery between January 2017 and December 2019, categorized as receiving no regional anesthesia (Group A), and receiving at least one modality of regional anesthesia (Group B)
3. Setting
1 tertiary care center, 1 community hospital
4. Patients
243 patients were included in the study (48.7% male, mean age 59.1 years). Indications for surgery included cancer (62%), empyema (12%), other pleural disease (13%), and tissue biopsy (13%). 40% of cases were robotic-assisted surgery, with the remainder being video-assisted thoracoscopic surgery (VATS).
5. Interventions
The intervention was the use of regional anesthesia: epidural infusion, serratus anterior plane (SAP) block, erector spinae plane (ESP) block, and/or intercostal nerve block.
6. Main Outcome Measure(s)
Maximum pain verbal rating (scale 1-10), inpatient opioid use, length of stay
7. Results
The average inpatient length of stay was the same between groups (4.3 days vs 4,1 days, p = 0.43). There was a reduction in the maximum pain verbal rating (5.9 ± 1.5 vs 4.3 ± 1.8, p = 0.001), and inpatient opioid use (229.2 ± 188.4 vs 148.7 ± 92.5 milligram morphine equivalents, p = 0.003). Of the patients receiving regional anesthesia, 52% (n = 69) had intra-operative placement of SAP catheters, with no statistical difference in pain score or opioid use compared to epidural analgesia or ESP blocks.
8. Conclusions
Regional anesthesia significantly decreases post-operative pain and opioid requirements after minimally invasive thoracic surgery. In this setting, intra-operative SAP catheter placement is as effective as epidural analgesia or ESP block.
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