Erector spinae plane block for urgent pleuroscopy: a possible change in anesthetic approach for high-risk patients
Ruggero Massimo Corso, Claudia Ravaglia, Nicoletta Fossati, Dusica Stamenkovic
Abstract
Dear Editor,
Pleuroscopy, also known as medical thoracoscopy, is a commonly performed diagnostic and therapeutic procedure regarded as the cornerstone of pleural disease management. The anesthetic management of these patients is not standardized, ranging from sedation with local anesthesia to general anesthesia with definitive airway control. Even if a considerable proportion of pleuroscopy patients have multiple comorbidities besides respiratory disease, pleuroscopy is usually performed in a bronchoscopy suite on an outpatient basis. The challenges in managing pleuroscopy cases include lateral decubitus positioning, iatrogenic pneumothorax, pendelluft ventilation, and sedation effects, which may result in significant respiratory compromise and potentially life-threatening complications. A trocar (6.5 to 11.5 mm) and a video-thoracoscope with a 0° optical telescope are inserted 1 to 2 cm on the midaxillary line between the fourth and seventh intercostal spaces; the procedure is painful, especially in the case of talc insufflation or biopsies, making perioperative pain control one of the fundamental goals of its anesthetic management.
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