Background and aims Video assisted thoracoscopy (VATS) is a frequently used method for both therapeutic and diagnostic purposes. VATS is usually performed under general anesthesia; however, paravertebral block or other regional techniques could be used as an option in selected patients undergoing thoracoscopic diagnostic biopsy. In this case presentation, we present the application of ultrasound guided erector spinae block (ESPB) for the management of a VATS case as a main anesthesia method.
Methods A 58 years old male patient who had a chest drain due to chronic right lung empyema after chemotherapy treatment due to lung cancer, was planned for diagnostic VATS. ESPB at level of T5 was applied with out-plane technique in lateral position under sedoanalgesia with midazolam 2 mg and fentanyl 25 mcg. Mixture of local anesthetics composed of 20 mL bupivacaine 0.5% and 10 mL lidocaine 2% was applied between transverse process and erector spinae muscle.
Results The sensorial block between T2-T7 dermatomes was confirmed with pinprick test after 30 minutes following block application. Deep dermal and subcutaneous surgical tissue biopsies were sampled in 4 abdominal quadrant. The video camera equipment was advanced into thorax cavity. Small lobular pathologies between lung parenchyma and thoracic wall were observed and dissected. The surgery lasted for 25 minutes. Whenever the patient revealed discomfort and mild pain additional 10 mg intravenous ketamine was applied and repeated three times.
Conclusions ESPB may be used for anesthesia in suitable diagnostic VAS cases. Further feasibility studies may be needed.