Thoracic Epidural Block versus Conscious Sedation with Intercostal Nerve Block for Thermal Ablation of Lung Tumors: A Comparative Study.

BACKGROUND

To evaluate the analgesic effects between thoracic epidural block (TEB) and conscious sedation with intercostal nerve block (CSINB) in patients undergoing thermal lung tumor ablation.

METHODS

Medical records of patients with primary or secondary lung tumors who underwent thermal lung tumor ablation between 2011 and 2022 were reviewed. Primary outcome measures were pain intensity evaluated using the visual analog scale (VAS) and additional morphine use within 48 hours after the procedure. Secondary outcome measures were adverse events during and after surgery.

RESULTS

Among 72 patients (median age 68, 61.1% male), 31 received CSINB and 41 received TEB. The TEB group had significantly fewer patients with VAS ≥ 5 (2.4% vs 25.8%, p = 0.004) and less additional morphine use (24.4% vs 77.4%, p < 0.001). Multivariable analysis showed that TEB reduced the risk of post-procedural pain (adjusted odds ratio [aOR], 0.04; 95% confidence interval [CI], 0.003-0.47) and additional morphine use (aOR: 0.08, 95% CI: 0.02-0.28). Hypotension occurred in 35 TEB patients and nausea in 5, both effectively managed with vasopressors and antiemetics. The incidence of fever, pneumothorax, pleural effusion, and pigtail drainage was similar between groups (p > 0.05).

CONCLUSION

TEB provides superior analgesia compared to CSINB. Although patients with reduced pulmonary function were not analyzed as a separate subgroup, the favorable analgesic outcomes and absence of respiratory depression in the TEB group-including those with prior lobectomy and limited pulmonary reserve-indicate that this technique may be appropriate for patients with compromised respiratory function.