Thoracic Surgical Operations Performed under Local Anesthesia and Sedation for Diagnosis and Treatment

Abstract

Generally, the operative procedures for the diagnosis or treatment of mediastinal, intrathoracic and/or chest wall lesions requiring rib resection are performed under general anesthesia. Although evidence suggests that thoracoscopy can be performed under local anesthesia, no report has indicated that some major thoracic procedures can be accomplished without general anesthesia. In our study, we advocate that certain surgical procedures could be performed under local anesthesia with a performance similar to that of general anesthesia. Thirty patients underwent thoracic procedures with local anesthesia and sedation for diagnosis and treatment. Seventeen of the patients were men, and the mean age of the patients was 49.6 years (range 16 to 71 years). There were 13 diagnostic procedures, and 17 procedures were for treatment purposes. The operative procedures performed using only local anesthesia were mini-thoracotomy (n = 9), mediastinotomy (n = 4), revision of a full-thickness posterolateral thoracic incision (n = 7), resection of the chondroma (n = 4), Eloesser flap (n = 1), metastasectomy of the chest wall (n = 3), empyectomy (n = 1), and video-assisted thoracoscopy (n = 2). Severity of pain was evaluated by VAS. There were no oral or intravenous analgesic requirements in the early postoperative period. No complications attributable to the procedure were observed. Thoracic surgical procedures for diagnosis and treatment performed under local anesthesia are simple, effective, economical and comfortable for the patient.

Key words

thoracic surgery - local anesthesia - pain

References

• 1 Ginsberg R J. Preoperative assessment of the thoracic surgical patient: a surgeon's viewpoint. Pearson FG Thoracic Surgery. London; Churchill Livingstone 1995: 29-36
• 2 Gilbert T B, Goodsell C W, Krasna M J. Bronchial rupture by a double-lumen endobronchial tube during staging thoracoscopy.  Anesth Analg. 1999;  88 1252-1253
• 3 de la Torre Bravos M, Rivas de Andres J J. Treatment of pneumothorax with VATS and bullectomy under local anesthesia. Video assisted thoracic surgery.  Ann Thorac Surg. 1999;  68 2383
• 4 Mukaida T, Andou A, Date H, Aoe M, Shimizu N. Thoracoscopic operation for secondary pneumothorax under local and epidural anesthesia in high-risk patients.  Ann Thorac Surg. 1998;  65 924-926
• 5 Takeno Y. A new therapy for the patient with spontaneous pneumothorax using electrocoagulation under thoracoscopic control (SPECT).  Panminerva Med. 1986;  28 83-84
• 6 Margolis M L. Non-small cell lung cancer: clinical aspects, diagnosis, staging and natural history. Fishman AP, Elias JA, Fishman JA, Grippi MA, Kaiser LR, Senior RM Fishman's Pulmonary Diseases and Disorders. 3rd ed. New York; McGraw-Hill 1999: 1759-1781
• 7 Ovassapian A. Conduct of anaesthesia. Shields TW, LoCicero J, Ponn RB General Thoracic Surgery. 5th ed. Philadelphia; Lippincott, Williams and Wilkins 2000: 327-344
• 8 Williams W, Goldstraw P, Evans T W. The complication of lung resection in adults: acute respiratory distress syndrome (ARDS).  Monal Arch Chest Dis. 1996;  51 310
• 9 Migliore M, Giuliano R, Aziz T, Saad R A, Sgalambro F. Four-step local anesthesia and sedation for thoracoscopic diagnosis and management of pleural diseases.  Chest. 2002;  121 2032-2035
• 10 Rusch V W, Mountain C. Thoracoscopy under regional anesthesia for the diagnosis and management of pleural disease.  Am J Surg. 1987;  154 274-278
• 11 Chapman C R, Synjala K L. Measurement of pain. Loesser JD Bonica's Management of Pain. Philadelphia; Lippincott, Williams and Wilkins 2001: 311-316