Thoracoscopic surgery under epidural anesthesia for intractable secondary spontaneous pneumothorax

Surgical intervention might be required in secondary spontaneous pneumothorax (SSP) with prolonged air leak; however, operation under general anesthesia (GA) could be critical in compromised patients. In this study, we performed video-assisted thoracic surgery (VATS) under epidural anesthesia (EA) in compromised patients with SSP and evaluated its feasibility.

Of 212 patients who underwent VATS for SSP, 179 patients had surgery under GA and 33 under EA from 2006 to 2014. All medical records were retrospectively reviewed for operative time, pre- and postoperative chest tube drainage, postoperative complications, and hospital death. To evaluate the efficacy of VATS under EA, these factors were compared between EA and GA groups.

The mean operative time and the mean duration of postoperative drainage, respectively was 106.2±45.3 minutes and 6.15±10.51 days in GA, and 102.6±43.1 minutes and 6.10±7.20 days in EA. Of 18 cases with recurrence and 13 cases with complications, only one recurrence and one complication developed in EA.

In case with patients having intractable SSP with compromised pulmonary function, VATS under EA could be an effective and safe option to approach the appropriate goals of air leak control and less recurrence of pneumothorax.