Thoracoscopic lung biopsy under regional anesthesia for interstitial lung disease

Chitaru Kurihara, Brian Tolly, Andre Dewolf, Antoun Nader, Samuel Kim, David D. Odell, Angela C. Argento*, G. R. Scott Budinger, Ankit Bharat

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background Interstitial lung disease (ILD) management guidelines support lung biopsy-guided therapy. However, the high mortality associated with thoracoscopic lung biopsy using general anesthesia (GA) in patients with ILD has deterred physicians from offering this procedure and adopt a diagnostic approach based on high-resolution CT. Here we report that thoracoscopy under regional anesthesia could be a safer alternative for lung biopsy and effectively guide ILD treatment. Methods This was a single-center retrospective review of prospectively maintained database and consisted of patients who underwent thoracoscopic lung biopsy between March 2016 and March 2018. Patients were divided into two groups: (A) GA, and (B) regional anesthesia using monitored anesthesia care (MAC) and thoracic epidural anesthesia (TEA). Results During the study period, 44 patients underwent thoracoscopic lung biopsy. Of these, 15 underwent MAC/TEA. There were no significant differences between the two groups with regard to pulmonary function test and clinicodemographic profile. However, operative time and hospital stay were shorter in MAC/TEA group (32.5±18.5 min vs 50.8±18.4; p=0.004, 1.0±1.3 days vs 10.0±34.7 days; p<0.001, respectively). Eight patients in the GA group, but none in the MAC/TEA group, experienced worsening of ILD after lung biopsy (p=0.03). Additionally, one patient in the GA group died due to acute ILD worsening. No cases of MAC/TEA group had to be converted to GA. In all cases a pathological diagnosis could be made. Conclusions Thoracoscopy using regional anesthesia might be a safer alternative to lung biopsy in patients with ILD.

Original languageEnglish (US)
Pages (from-to)255-259
Number of pages5
JournalRegional anesthesia and pain medicine
Volume45
Issue number4
DOIs
StatePublished - Apr 1 2020

Keywords

  • acute pain
  • alternative therapies
  • intravenous regional anesthesia

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Fingerprint Dive into the research topics of 'Thoracoscopic lung biopsy under regional anesthesia for interstitial lung disease'. Together they form a unique fingerprint.

  • Cite this