A Review of Analgesic and Anaesthetic Approaches in Local Anaesthetic (Medical) Thoracoscopy

Pleural disease is a subspecialist area of respiratory medicine, requiring diagnostic and therapeutic interventions. The most invasive pleural procedure is local anaesthetic thoracoscopy (LAT) used in the context of unexplained exudative pleural effusions. LAT can be exquisitely painful because of instrumentation of the parietal pleura which carries all nociceptive nerve endings. The optimal anaesthetic and analgesic requirement for LAT is not known, and recommendations are based on expert opinions and small usually single-centre studies. We provide a narrative description of existing literature, show the potential application of regional nerve blocks for LAT and provide practice points.