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Original research
Thoracoscopic lung biopsy under regional anesthesia for interstitial lung disease
  1. Chitaru Kurihara1,
  2. Brian Tolly2,
  3. Andre DeWolf2,
  4. Antoun Nader2,
  5. Samuel Kim1,
  6. David D Odell1,
  7. Angela C Argento3,
  8. G R Scott Budinger3 and
  9. Ankit Bharat1
  1. 1 Department of Surgery, Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2 Department of Medicine, Division of Anesthesiology and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
  3. 3 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  1. Correspondence to Dr Chitaru Kurihara, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; chitaru1207{at}gmail.com

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.

  • acute pain
  • intravenous regional anesthesia
  • alternative therapies

https://doi.org/10.1136/rapm-2019-100686

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    Footnotes

    • Contributors CK: collecting data, writing, revising. BT: writing, revising. AD, AN, SK, DDO, ACA, GRSB: editing. AB: editing, concept, writing, revising.

    • Funding This work was supported by the National Institutes of Health (HL125940, HL145478, HL147290, and HL147575 to AB).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.