Benefits of Using Peripheral Nerve Blocks for Medical Thoracoscopy

Medical thoracoscopy (MT) is a minimally invasive procedure performed to diagnose and treat pleural disorders. MT is usually accomplished with the use of monitored anesthesia care (MAC) and local anesthetic (LA) infiltration. There is little data regarding the analgesic benefits and use of peripheral nerve blocks (PNB) for MT. A retrospective review was done looking at patients who underwent MT at a single center in New York City from January 2021 to September 2023, comparing the procedural times, intraoperative opioid consumption, and postoperative opioid consumption in the post-anesthesia care unit (PACU) of patients who received a PNB with MAC versus MAC alone. Ninety records were queried, 23 (25.6%) had a PNB, of which 14 (60.8%) received an erector spinae plane block (ESPB) and 9 (39.1%) received a serratus anterior plane block (SAPB). 67 (74.4%) received MAC alone. When comparing those who received a PNB with MAC versus MAC alone, there was a reduction in procedure time (34 vs. 40 min, P=0.007), in-room time (53 vs. 68 min, P=<0.001), median use of intraoperative opioids (milligram morphine equivalent, 3.0 vs. 6.0, P=<0.001), and overall need for dexmedetomidine (0 vs. 20.9%, P=0.04). There was no difference in the intraoperative opioid use or postoperative opioid consumption recorded in PACU. The addition of a PNB, either SAPB or ESPB, to MAC for MT is safe and might reduce procedural time and overall intraoperative opioid use. However, larger randomized clinical trials are necessary to confirm these findings.