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

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Abstract

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.

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Data availability

The datasets used during the present study are available from the corresponding author upon reasonable request.

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Funding

This research received no external funding.

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Author notes

  1. Roberto Bellini and Maria Chiara Salandini equally contributed to the present work and as co-first authors.

Authors and Affiliations

  1. General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy

    Roberto Bellini, Maria Chiara Salandini, Stefano Granieri & Christian Cotsoglou

  2. Service de Chirurgie Digestive, Centre Hospitalier d’Antibes Juan-Les-Pins, 107, av. de Nice, 06600, Antibes, France

    Andrea Chierici

  3. Anesthesia and Resuscitation Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy

    Rita Passaretta

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  1. Roberto Bellini
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Contributions

Conceptualization, RB and MCS; methodology, SG and AC; software, SG.; validation, RB, MCS, SG, and AC, and CC; formal analysis, XX; investigation, RB, MCS, SG, and AC; data curation, SG; writing—original draft preparation, MCS, RB, and SG; writing—review and editing, MCS, RB, SG, and AC; visualization, RB, MCS, SG, AC, RP, and CC; supervision, RB and CC; project administration, RB and MCS. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Maria Chiara Salandini.

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Due to the retrospective nature of the study, an institutional review Board approval was not required.

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Bellini, R., Salandini, M.C., Granieri, S. et al. Erector spine plane block as single loco-regional anesthesia in non-intubated video-assisted thoracic surgery for unfit patients: a case-match study. Updates Surg 75, 1019–1026 (2023). https://doi.org/10.1007/s13304-023-01464-0

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  • DOI: https://doi.org/10.1007/s13304-023-01464-0

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