AUTHORS

G. Adamo, M. Amata, G. Arcoleo, MR. Bonsignore, P. Mazzotta, F. Tarantino, B. Renda.

INTRODUCTION

In early treatment and diagnosis of pleural diseases, MT represents an excellent alternative to VATS (video-assisted thoracoscopic surgery). MT is usually performed in spontaneously breathing subjects with combination of IV opioids, propofol/midazolam and topical lidocaine.

AIMS

To verify if MT, performed under locoregional anesthesia and mild sedation, without using opioids, is able to keep optimal pain control during and after the procedure, while maintaining high diagnostic yields.

METHODS

We included 16 adult patients (mean age 64 ± 12) undergoing MT, between October 2022 and February 2023. Patients underwent locoregional anesthesia (ropivacaine and dexamethasone) with SPB, combined with ESP block in 8 patients, under mild sedation (midazolam and/or propofol IV). A PANOVIEW thoracoscope 4.0 mm was used. 14 patients enrolled were ASA 3; 2 were ASA 2. Pain was registered at 12, 24 and 36 h.

RESULTS 

We obtained a diagnosis in 15 patients (cancer in 5, empyema in 3 and non-specific pleurisy in 7 patients); last patient?s diagnosis was uncertain. No adverse event occurred. Just 4 patients needed administration of NSADs or Acetaminophen as painkillers in the following 36 ours. No patients needed use of opioid painkillers.

CONCLUSIONS

This opioid-free MT protocol effectively controlled pain, avoided opioid-related problems (nausea, respiratory depression or constipation) and achieved high diagnostic yields.