Role of loco-regional anesthesia for non-intubated video-assisted thoracoscopic surgery: A tertiary care hospital in northern Thailand

Locoregional anesthesia for non-intubated video-assisted thoracoscopic surgery


  • Tanyong Pipanmekaporn Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • Prangmalee Leurcharusmee Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • Artid Samerchua Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • Suraphong Lorsomradee Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • Settapong Boonsri Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • Krit Panjasawatwong Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • Sophon Siwachat Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand


Non-intubated thoracoscopic surgery, Thoracic epidural anesthesia, Intercostal nerve block, Thoracic paravertebral block


Background: A few studies have focused on the role of regional anesthesia for non-intubated thoracoscopic surgery (NIVATS) in Thailand. The purpose of the present study was to review the feasibility and safety of loco-regional anesthesia for NIVATS in a tertiary care hospital.

Methods: All patients undergoing scheduled NIVATS under loco-regional anesthesia including thoracic epidural analgesia (TEA), intercostal nerve block (ICNB), thoracic paravertebral block, and local wound infiltration from 2018 to 2021 were assessed by a retrospective chart review. Sedation was performed with propofol infusion and bispectral index monitoring. Primary outcomes were the feasibility of surgery and safety related to loco-regional anesthesia techniques.

Results: Twenty-three patients were included. The average age was 43 (26-59) years.  The two most common regional anesthesia techniques in this study were TEA and ICNB. The most common surgical procedure was wedge resection (13 patients, 56.5%) followed by pleurectomy (5 patients, 21.7%). The overall feasible scores were 2.6 ± 0.7. Intraoperative hypotension (62.5% for TEA vs 20% for ICNB) and urinary retention (25% for TEA vs 0 for ICNB) were found. Among four patients with severe cough, three patients received intrathoracic vagal block and one patient required general anesthesia due to severe hypoxemia. Patients with ICNB had a higher degree of incisional pain and a higher amount of postoperative morphine consumption.

Conclusion: NIVATS under loco-regional anesthesia could be a feasible and safe technique. A further study is recommended to compare the efficacy and safety of TEA and ICNB for NIVATS.


Schieren M, Defosse J. To tube or not to tube: a skeptic’s guide to nonintubated thoracic surgery. Curr Opin Anesthesiol 2021;34:1-6.

de la Gala F, Piñeiro P, Reyes A, Vara E, Olmedilla L, Cruz P, et al. Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomized controlled trial comparing intravenous and inhalational anaesthesia. Br J Anaesth 2017;119:655-63.

Pipanmekaporn T, Bunchungmongkol N, Punjasawadwong Y, Lapisatepun W, Tantraworasin A, Saokaew S. A risk score for predicting respiratory complications after thoracic surgery. Asian Cardiovasc Thorac Ann 2019;27:278-87.

Pompeo E, Tacconi F, Mineo D, Mineo TC. The role of awake video-assisted thoracoscopic surgery in spontaneous pneumothorax. J Thorac Cardiovasc Surg 2007;133:786-90.

Pompeo E, Mineo D, Rogliani P, Sabato AF, Mineo TC. Feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules. Ann Thorac Surg 2004;78:1761-8.

Pompeo E, Rogliani P, Tacconi F, Dauri M, Saltini C, Novelli G, et al. Randomized comparison of awake nonresectional versus nonawake resectional lung volume reduction surgery. J Thorac Cardiovasc Surg 2012;143:47-54.

Wu CY, Chen JS, Lin YS, Tsai TM, Hung MH, Chan KC, et al. Feasibility and safety of nonintubated thoracoscopic lobectomy for geriatric lung cancer patients. Ann Thorac Surg 2013;95:405-11.

Pompeo E, Rogliani P, Cristino B, Schillaci O, Novelli G, Saltini C. Awake thoracoscopic biopsy of interstitial lung disease. Ann Thorac Surg 2013;95:445-52.

Irons JF, Martinez G. Anaesthetic considerations for non-intubated thoracic surgery. J Vis Surg 2016;2:61. doi: 10.21037/ jovs.2016.02.22.

Katlic MR, Facktor MA. Video-assisted thoracic surgery utilizing local anesthesia and sedation: 384 consecutive cases. Ann Thorac Surg 2010;90:240-5.

Mukaida T, Andou A, Date H, Aoe M, Shimizu N. Thoracoscopic operation for secondary pneumothorax under local and epidural anesthesia in high-risk patients. Ann Thorac Surg 1998;65:924-6.

Liu J, Cui F, Li S, Chen H, Shao W, Liang L, et al. Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: a randomized control study. Surg Innov 2015;22:123-30.

Hung MH, Hsu HH, Chen KC, Chan KC, Cheng YJ, Chen JS. Nonintubated thoracoscopic anatomical segmentectomy for lung tumors. Ann Thorac Surg 2013;96:1209-15.

Chen JS, Cheng YJ, Hung MH, Tseng YD, Chen KC, Lee YC. Nonintubated Thoracoscopic Lobectomy for Lung Cancer. Ann Surg 2011;254:1038-43.

Tacconi F, Pompeo E, Fabbi E, Mineo TC. Awake video-assisted pleural decortication for empyema thoracis. Eur J Cardiothorac Surg 2010;37:594-601.

Chen KC, Cheng YJ, Hung MH, Tseng YD, Chen JS. Nonintubated thoracoscopic surgery using regional anesthesia and vagal block and targeted sedation. J Thorac Dis 2014;6:31-6.

Hung MH, Chan KC, Li YJ, Chan KC, Cheng YJ, Chen JS. Nonintubated thoracoscopic lobectomy for lung cancer using epidural anesthesia and intercostal blockade: A retrospective cohort study of 238 cases. Medicine 2015;94:e727. doi: 10.1097/MD. 0000000000000727.

Corso RM, Piraccini E, Byrne H, Poggi P, Tedesco M. The serratus anterior plane block for pediatric non-intubated video-assisted thoracoscopic surgery. Minerva Anestesiol 2017;83:775-6.

Kiss G. Technical issues and patient safety in nonintubated thoracic anesthesia. Thorac Surg Clin 2020;30:1-13.

Laohathai S, Pathonsamit C, Isaranimitkul D, Wannadilok P, Poopipatpab S, Weerayutwattana R. Non-intubated video-assisted thoracoscopic surgery for pulmonary resection in children. Journal of Pediatric Surgery Case Reports 2021;74:102015.

Laohathai S, Wannadilok P, Poopipatpab S, Pathonsamit C. Nonintubated video-assisted thoracoscopic surgery using local anesthesia for catamenial pneumothorax. Ann Thorac Surg 2021;111:e245-e6.

Pathonsamit C, Laohathai S. Non-intubated uniportal video-assisted thoracoscopic surgery (NIVATS): First case report in Thailand. J Med Assoc Thai 2019;102:125.

Tran DQ, González AP, Bernucci F, Finlayso RJ. Confirmation of loss-of-resistance for epidural analgesia. Reg Anesth Pain Med 2015;40:166-73.

Leurcharusmee P, Arnuntasupakul V, Chora De La GD, Vijitpavan A, Ah-Kye S, Saelao A, et al. Reliability of waveform analysis as an adjunct to loss of resistance for thoracic epidural blocks. Reg Anesth Pain Med 2015;40:694-7.

Li H, Huang D, Qiao K, Wang Z, Xu S. Feasibility of non-intubated anesthesia and regional block for thoracoscopic surgery under spontaneous respiration: a prospective cohort study. Braz J Med Biol Res 2020;53:e8645. doi: 10.1590/1414-431X20198645.

Hung MH, Hsu HH, Chan KC, Chen KC, Yie JC, Cheng YJ, et al. Non-intubated thoracoscopic surgery using internal intercostal nerve block, vagal block and targeted sedation. Eur J Cardiothorac Surg 2014;46:620-5.

Tacconi F, Pompeo E, Sellitri F, Mineo TC. Surgical stress hormones response is reduced after awake videothoracoscopy. Interact Cardiovasc Thorac Surg 2010;10:666-71.

Michel-Cherqui M, Szekely B, Lemoyne F, Feliot E, Gayat E, Fischler M. Auriculotherapy in the prevention of postoperative urinary retention in patients with thoracotomy and thoracic epidural analgesia: A randomized, double-blinded trial. Medicine 2019;98: e15958. doi: 10.1097/MD.0000000000015958.

Baldini G, Bagry H, Aprikian A, Carli F, Warner DS, Warner MA. Postoperative urinary retention: nesthetic and perioperative considerations. Anesthesiology 2009;110:1139-57.

Gonzalez-Rivas D, Bonome C, Fieira E, Aymerich H, Fernandez R, Delgado M, et al. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur J Cardiothorac Surg 2016;49:721-31.

Guo Z, Shao W, Yin W, Chen H, Zhang X, Dong, Q. et al. Analysis of feasibility and safety of complete video-assisted thoracoscopic resection of anatomic pulmonary segments under non-intubated anesthesia. J Thorac Dis 2014;6:37-44.

Gonzalez-Rivas D, Fernandez R, de la Torre M, Rodriguez JL, Fontan L, Molina F. Single-port thoracoscopic lobectomy in a nonintubated patient: the least invasive procedure for major lung resection? Interact Cardiovasc Thorac Surg 2014;19:552-5.

Al-Abdullatief M, Wahood A, Al-Shirawi N, Arabi Y, Wahba M, Al-Jumah M, et al. Awake anaesthesia for major thoracic surgical procedures: an observational study. Eur J Cardiothorac Surg 2007;32:346-50.




How to Cite

Pipanmekaporn T, Leurcharusmee P, Samerchua A, Lorsomradee S, Boonsri S, Panjasawatwong K, Siwachat S. Role of loco-regional anesthesia for non-intubated video-assisted thoracoscopic surgery: A tertiary care hospital in northern Thailand: Locoregional anesthesia for non-intubated video-assisted thoracoscopic surgery. Clin Crit Care [Internet]. 2021 Nov. 11 [cited 2024 Jun. 20];29:2021:e0008. Available from:



Original Articles