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

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

    Kurihara, C., Tolly, B., Dewolf, A., Nader, A., Kim, S., Odell, D. D., Argento, A. C., Scott Budinger, G. R., & Bharat, A. (2020). Thoracoscopic lung biopsy under regional anesthesia for interstitial lung disease. Regional Anesthesia and Pain Medicine, 45(4), 255-259. https://doi.org/10.1136/rapm-2019-100686