VIDEO-ASSISTED TALC PLEURODESIS FOR MALIGNANT PLEURAL EFFUSIONS UTILIZING LOCAL-ANESTHESIA AND IV SEDATION

Methods: Twenty-four consecutive patients aged 36 to 84 rears (mean, 6 3.3+/-12.9 years) underwent video-assisted talc pleurodesis (VATP) for malignant pleural effusion (MPE) utilizing local anesthesia with IV s edation at the Walter Reed Army Medical Center. The VATP procedure was pet-formed in the operating room with the patient in the lateral decu bitus position breathing spontaneously through a face mask with 4 L/mi n of oxygen. Anesthesia was achieved by intel costal 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 (Surgi-port) sites as necessary. Sedation was achieved with pro pofol, and pleurodesis was performed with 3 to 8 g (average, 5 g) of s terile talc insufflated through a talc atomizer. Results: The mean ope rating time was 44.3+/-14.9 min (range, 23 to 75 min). The average num ber of days of chest tube drainage was 2.9+/-1.2 days (range, 1 to 5 d ays). Patients stayed on tile cardiothoracic ward for an average of 4. 4+/-1.3 days before discharge home or transfer to a medical oncology w ard. Seventeen of the 24 patients (71%) had excellent results, 4 patie nts (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 mo nths, 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 month s after VATP. Conclusions: VATP, performed under local anesthesia, is a safe and highly effective method of managing MPE.