A comparative study between Thoracic Epidural Anesthesia in non-intubated video-assisted thoracoscopes and the conventional general anesthesia with one lung ventilation

Abstract

Background Video-assisted thoracoscopic surgery (VATS) refers to the minimally invasive thoracic surgeries performed by video cameras to avoid the invasive conventional open thoracotomy. The majority necessitate one-lung ventilation. Regional anesthesia is involved to avoid the risks of general anesthesia(GA) and one-lung ventilation and promote efficient recovery of these vulnerable populations.Objective To assess the feasibility of non-intubated VATS with Thoracic Epidural Anesthesia (TEA) compared to the conventional GA in terms of hemodynamic and ventilatory parameters, postoperative pain control, opiate consumption, ambulation, and length of hospital stay.Patients and Methods This study is a prospective randomized clinical study conducted in Ain Shams University Hospitals over 2 years, with a sample size of 40 patients in 2 groups. The GA group, after induction of anesthesia, double-lumen endotracheal tube was inserted to facilitate one-lung ventilation. The TEA group, an epidural catheter was inserted between T3 and T4 orT4 and T5 intervertebral space, local anesthetic dose titrated aiming to achieve sensory and motor block between C7-T7 levels.Results The findings revealed no statistically significant difference between groups throughout the perioperative period (p >0.05) regarding ventilatory and circulatory parameters besides opiate consumption. Conversely, in terms of postoperative ambulation and length of hospital stay (LOS), p-value=0.013 and 0.001 respectively for each favoring the TEA group. Similar results were denoted for postoperative pain control, there was statistically significant difference between groups in VAS score at 3 hours (P =0.004).Conclusion The feasibility of nonintubated VATS with TEA was tested with respect to safety and efficiency compared to the conventional GA. The results of both groups are comparable in terms of hemodynamics and ventilatory parameters. Despite similar overall opiate consumption in both groups, the TEA group demonstrated promising results regarding the enhanced recovery parameters in terms of better early postoperative pain control, earlier ambulation, and decreased length of hospital stay.

Keywords

• Thoracic epidural
• one-lung ventilation
• nonintubated VATS