Treatment of Pleural Effusions with Nonintubated Video-Assisted Thoracoscopic Surgery

Analgesic comparison of erector spinae plane block with intercostal nerve block for thoracoscopic surgery: A meta-analysis of randomized controlled trials

INTRODUCTION

The analgesic efficacy of erector spinae plane block (ESPB) versus intercostal nerve block (ICNB) for thoracoscopic surgery remains controversial. We conducted a systematic review and meta-analysis to explore the impact of ESPB versus ICNB on thoracoscopic surgery.

METHODS

We searched PubMed, EMbase, Web of Science, EBSCO, and Cochrane library databases through May 2023 for randomized controlled trials (RCTs) assessing the effect of ESPB versus ICNB on thoracoscopic surgery. This meta-analysis was performed using the random-effect model or fixed-effect model based on the heterogeneity.

RESULTS

Four RCTs and 203 patients are included in the meta-analysis. Overall, compared with ICNB for thoracoscopic surgery, ESPB results in significantly reduced pain scores at 48 hours (SMD [standard mean difference] = -3.49; 95% CI [confidence interval] = -6.76 to -0.21; P = .04), but demonstrated no impact on pain scores at 24 hours (SMD = -0.04; 95% CI = -1.24 to 1.16; P = .95), pain scores at 4 to 6 hours (SMD = -0.16; 95% CI = -2.02 to 1.71; P = .87), pain scores at 12 hours (SMD = -0.16; 95% CI = -2.38 to 2.05; P = .88) or analgesic consumption (SMD = 0.27; 95% CI = -0.80 to 1.35; P = .62).

CONCLUSIONS

ESPB may be comparable with ICNB for the postoperative pain control of thoracoscopic surgery.

Massive secretions in paragonimiasis pleural effusion: a new finding concerning clinical recognition and treatment

Some paragonimiasis patients in Chongqing, southwest China, have recently exhibited pleural effusions (PEs) with massive viscous secretions. This study aimed to investigate their clinical characteristics, thereby promoting effective treatments. A 3-year retrospective review of paragonimiasis patients who were admitted for nonhomogeneous PEs at Chongqing University Three Gorges Hospital was conducted. Epidemiological data, symptoms, laboratory and imaging findings, treatments, and outcomes were analyzed. Twenty-eight patients were identified, of which 22 (78.6%) were males and 22 (78.6%) were rural residents. Respiratory (85.7%) and constitutional (57.1%) symptoms were common. Paragonimus-specific ELISA was positive in all patients. Eosinophilia was detected in all patients in peripheral blood and PEs. Irregular hyperdense signals were observed in PEs by chest CT scans (96.4%) and ultrasonography (100.0%). Thoracic closed drainage failed in 10 patients (conservative group) because of tube blockage and was eventually replaced by video-assisted thoracoscopic surgery (VATS). Eighteen patients (surgery group) initially underwent VATS, or thoracotomy surgery, without complications. Massive secretions, described as "bean-dregs" or "egg-floccule," were detected intraoperatively, which explained the imaging findings and tube blockage. All patients recovered well after 2-3 courses of postoperative praziquantel treatment. Viscous secretions in paragonimiasis patients warrant great concern. Irregular hyperdense signals in effusions are important characteristics in CT scans and ultrasonography. Treatments such as thoracic closed drainage may fail due to viscous secretions blocking the tube; therefore, surgeries should be considered. In-depth multidisciplinary research may help determine the optimal treatment strategy and reveal the origin of these secretions.

Curative Effect Observation and Prognosis Analysis of Video-Assisted Thoracic Surgery and Thoracotomy in Patients with Hemopneumothorax

Currently, the incidence of hemopneumothorax is high in China, and with the continuous improvement of modern medical standards, video-assisted thoracoscopic surgery (VATS) has gradually become the main method of clinical treatment of hemopneumothorax. The aim of this study was to investigate the minimally invasive mechanism and the clinical value of television thoracoscopy in the diagnosis and treatment of traumatic hemopneumothorax and to provide a relevant theoretical basis for the superiority of television thoracoscopy. In this study, total of 98 patients with traumatic hemopneumothorax admitted to three hospitals from January 2017 to December 2019 were selected and divided into 49 cases each in the thoracotomy group and VATS group according to the differences of the surgical method. The surgical situation such as operation time, intraoperative bleeding, and incision length, postoperative recovery such as duration of painkiller use, chest tube retention time, volume of drainage, and hospital stay, levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and other inflammatory factors at different times after admission to hospital, postoperative complications such as pulmonary infection, enveloped effusion, incisional infection, and pressureulcers, and recurrence rate at 12-month follow-up were used as the evaluation indexes to analyze the effect of different surgical treatment modalities in patients with hemopneumothorax and the impact on patient prognosis. The results showed that the operative time, intraoperative bleeding, duration of painkiller use, chest tube retention time, and hospital stay were shorter in the VATS group than in the thoracotomy group. The length of the surgical incision, volume of drainage, and inflammatory factor levels at different postoperative periods were lower in the VATS group than in the thoracotomy group. The incidence of postoperative complications was lower in both groups, and the difference was not statistically significant. The follow-up results showed that there were no recurrent cases in both groups 12 months after discharge. This indicates that VATS is an effective treatment option for hemopneumothorax, which can achieve the same exploration and treatment effect as thoracotomy, and has the advantages of less trauma, less bleeding, shorter operation time, and faster postoperative recovery compared with thoracotomy. The prognosis of patients treated by VTAS is good, which provides a new treatment route for patients who cannot tolerate thoracotomy and are poorly tolerated.