Local fluid application and needle insertion in gravity-dependent areas to reduce the risk of pneumothorax during lung nodule localization: a single-center observational study.

BACKGROUND

Pneumothorax is a common and clinically significant complication during computed tomography (CT)-guided preoperative lung nodule localization. This study aimed to evaluate the clinical outcomes of a novel strategy-combining extrapleural local fluid application with gravity-dependent needle insertion-for reducing the risk of pneumothorax in an observational setting.

METHODS

A total of 166 patients who underwent preoperative CT-guided percutaneous pulmonary nodule (PN) localization and completed thoracoscopic surgery at The First Affiliated Hospital of Kunming Medical University between June 1, 2024, and November 1, 2024, were included in this study. Patients were grouped based on whether they received the CT-guided injection of 2% lidocaine outside the parietal pleura and the area of the localization needle insertion point. Baseline information, nodule-related details, localization-related data, and complications were collected and compared between groups and subgroups.

RESULTS

The pneumothorax incidence was analyzed among the four groups: FD (fluid application + gravity-dependent area) group: 1/33 case (3%) < FnD (fluid application + non-dependent area) group: 4/44 cases (9%) < nFD (non-fluid application + gravity-dependent area) group: 6/36 cases (17%) < nFnD (non-fluid application + non-dependent area) group: 19/37 cases (51%), with statistically significant differences (P<0.001). Multivariate analysis indicated that lidocaine injection beneath the pleura [P<0.001, odds ratio (OR) =0.07, 95% confidence interval (CI): 0.02-0.24] and needle insertion in gravity-dependent areas (P<0.001, OR=0.16, 95% CI: 0.05-0.48) were independent risk factors for pneumothorax. In the F group (FD + FnD), 53% of patients reported no pain (score 0), and 47% experienced mild pain (score 1-3). In the nF group (nFD + nFnD), 91% of patients experienced mild pain, and 9% reported moderate pain (score 4-6), with P<0.001. Complication-related analysis showed a positive correlation between pneumothorax and pain, as well as between pain and pleural reactions, with statistically significant differences.

CONCLUSIONS

Prior to percutaneous CT-guided lung nodule localization, the precise administration of 10 mL of lidocaine external to the parietal pleura, coupled with the selection of an appropriate needle insertion site within the gravity-dependent region, can reduce the incidence of pneumothorax during CT-guided localization of PNs. The use of lidocaine outside the parietal pleura can reduce the pain felt by patients during the localization process, increase comfort, and enhance the embodiment of humanistic care.