ANAESTHETIC MANAGEMENT FOR VIDEO ASSISTED THORACOSCOPY IN A CASE OF MASSIVE MALIGNANT PLEURAL EFFUSION

Abstract

Background: Video-Assisted Thoracic Surgery (VATS) for massive pleural effusion poses unique anaesthetic challenges. Combining a Laryngeal Mask Airway (LMA) with an Erector Spinae Plane (ESP) block offers a minimally invasive approach that reduces airway manipulation, provides effective multi-dermatomal analgesia, and limits opioid use—beneficial in patients with compromised respiratory function.[1][2]

Case Presentation: A 63-year-old male, a known case of right nodal mass (T4 N3 M1), right internal jugular vein thrombosis, and moderate pericardial effusion, was scheduled for VATS for massive malignant pleural effusion. Anaesthesia was managed using a combined technique of ESP block and general anaesthesia, with airway secured using a classic LMA.

Discussion: The combination of ESP block and LMA offers a minimally invasive anaesthetic strategy for VATS in high-risk patients. This approach provides excellent pain control, reduces perioperative opioid use, and maintains adequate ventilation without endotracheal intubation. Minimizing airway manipulation is particularly beneficial in patients with compromised cardiopulmonary status. Additionally, effective regional analgesia supports early ambulation and recovery, which is vital for postoperative outcomes in patients with advanced malignancy and poor respiratory reserve.[3]

Conclusion: The use of ESP block with LMA is a safe and effective anaesthetic technique for VATS in patients with massive pleural effusion.[4] It offers significant advantages in terms of analgesia, airway management, and recovery, making it a valuable option in selected high-risk cases.