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Updated: Jun 21, 2025

Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
Bupivacaine pleural effusion mimicking a hemothorax after a thoracoscopic microdiscectomy with epidural anesthesia
Maarten Te Dorsthorst-Maas1,2, Yvonne L J Vissers3, Nico M Grupa4
1Department of Neurosurgery, Zuyderland Medical Center, Heerlen, the Netherlands. m.tedorsthorst@zuyderland.nl.
Purpose:
Post-operative pain after video-assisted thoracoscopic surgery is often treated using thoracic epidural analgesics or thoracic paravertebral analgesics. This article describes a case where a thoracic disc herniation is treated with a thoracoscopic microdiscectomy with post-operative thoracic epidural analgesics. The patient developed a bupivacaine pleural effusion which mimicked a hemothorax on computed tomography (CT).
Methods:
The presence of bupivacaine in the pleural effusion was confirmed using a high performance liquid chromatography method.
Results:
The patient underwent a re-exploration to relieve the pleural effusion. The patient showed a long-term recovery similar to what can be expected from an uncomplicated thoracoscopic microdiscectomy.
Conclusion:
A pleural effusion may occur when thoracic epidural analgesics are used in patents with a corridor between the pleural cavity and epidural space.
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