Anesthesia Management in Non-Intubated Thoracoscopic Surgery (NIVATS): A Retrospective Study

Objectives: Video-assisted thoracoscopic surgery (VATS) is a widely used technique for thoracic operations. Non-intubated VATS (NIVATS) under regional or local anesthesia can be performed in selected patients. Epidural analgesia or interfascial plane blocks can be used for successful NIVATS. Erector spinae plane block (ESPB) is a type of interfascial plane block that is effective for NIVATS procedures. At our clinic, we successfully perform NIVATS with ESPB or rhomboid intercostal plane block (RIB). In this paper, we assess the effectiveness of these anesthesia methods used during NIVATS procedures.
Methods: We retrospectively reviewed 61 patients that underwent NIVATS procedures at our clinic between November 2017 and August 2023. This study received ethical committee approval (2023.255.IRB1.084). These 61 patients were assessed based on their demographic information, ASA grades, procedure indication, procedure duration, post-procedure complications, and type of anesthesia.
Results: All 61 patients received intraoperative sedation. Of these,16 received epidural analgesia, 10 received ESPB, 6 received RIB, and 29 received local anesthesia. Perioperative care did not differ between groups and all surgeries were completed without complications. No patients required transition to general anesthesia.
Conclusion: Patients in the epidural group were younger, which we think correlates with increasing comorbidities and anticoagulant usage with age. Other parameters were similar between groups. Overall, we recommend further prospective studies with larger sample sizes to evaluate the outcomes of different anesthesia techniques for NIVATS procedures.