Video-assisted talc pleurodesis for malignant pleural effusions utilizing local anesthesia and I.V. sedation

Twenty-four consecutive patients aged 36 to 84 years (mean, 63.3+/-12.9 years) underwent video-assisted talc pleurodesis (VATP) for malignant pleural effusion (MPE) utilizing local anesthesia with IV sedation at the Walter Reed Army Medical Center. The VATP procedure was performed in the operating room with the patient in the lateral decubitus position breathing spontaneously through a face mask with 4 L/min of oxygen. Anesthesia was achieved by intercostal nerve block using a 50/50 mixture of 1% lidocaine with epinephrine and 0.5% bupivacaine hydrochloride (Marcaine) supplemented with local infiltration of the access (Surgiport) sites as necessary. Sedation was achieved with propofol, and pleurodesis was performed with 3 to 8 g (average, 5 g) of sterile talc insufflated through a talc atomizer.

The mean operating time was 44.3+/-14.9 min (range, 23 to 75 min). The average number of days of chest tube drainage was 2.9+/-1.2 days (range, 1 to 5 days). Patients stayed on the cardiothoracic ward for an average of 4.4+/-1.3 days before discharge home or transfer to a medical oncology ward. Seventeen of the 24 patients (71%) had excellent results, 4 patients (17%) had good results, and 3 patients (12%) had poor results. The three patients with poor results all had primary lung cancer as their underlying malignancy. The overall actuarial survival was 66% at 6 months, 48% at 12 months, and 32% at 24 months with a mean survival of 9 months. There was one operative death in an 84-year-old patient with primary lung cancer. Twelve of the 24 patients are alive 4 to 30 months after VATP.

VATP, performed under local anesthesia, is a safe and highly effective method of managing MPE.