Intrapleural anaesthesia for medical thoracoscopy - a pilot study

Background: Medical thoracoscopy (MT) has major role in diagnossis of exudative pleural effusion. MT is usually performed under conscious sedation (CS). Some patients suffer considerable pain during pleura biopsy or pleurodesis. The use of CS is occasionally complicated by respiratory failure. This study aimed to evaluate if intrapleural anaesthesia (IPA) using lidocaine via chest drain improves patient9s tolerability of MT. Mehtods: Patients were divided to 2 groups. In group 1: CS using IV midazolam with standard doses was done. In group 2: a chest drain was inserted to dry the affected side overnight. 20 min before procedure, 1 mg/kg of 1% lidocaine in 20 ml saline were instilled via drain and then clamped. Rigid scope was used. At the start of the MT, drain was removed, and pneumothorax was allowed to develop. The remainder of the MT procedure was carried out in the same manner in both groups. 10-cm Visual analogue score (VAS) for pain was recorded after the procedure. Results: Mean age in group 1 was 56+10 yrs while in group 2 it was 58+12 yrs. 2/10 patients were females in CS group, while in IPA group 7/10 were females. 50% of CS patients had CV comorbidities, which affected 60% of group 2 patients. Diagnosis was successfully made in all patients. 90% of patients in both groups had malignant pleural disease. The median VAS for pain during MT in CS was 8 (6.75-9), while with IPA it was 1 (0-3.75) (p 0.001). One major complication occurred in a case in CS group who had acute hypoventilation. 8/10 patients in CS and 1/10 patient in IPA group required IV analgesia after procedure. Conclusion: IPA appears to be associated with less pain during MT without decreasing yield. It might be a safer choice than CS.