Tubeless anesthesia with preserved spontaneous breathing: safe and effective in enhanced recovery after thoracoscopic wedge resection of the lung

Background: The concept of tubeless anesthesia has emerged as a transformative approach in modern anesthesiology, particularly within the framework of enhanced recovery after surgery (ERAS). However, research regarding the application of tubeless anesthesia in the context of thoracoscopic wedge resection remains limited, particularly with respect to comparative studies of different anesthesia techniques, such as the use of a laryngeal mask airway (LMA) combined with various nerve block approaches. This prospective study evaluated the feasibility and safety of tubeless anesthesia in thoracoscopic wedge resection and its impact on rapid postoperative recovery, providing more evidence for clinical practice.

Methods: Ninety patients scheduled for thoracoscopic wedge resection were randomized into three groups, with 30 patients in each group: double-lumen endotracheal intubation (Group A), LMA + intercostal nerve block (Group B), and LMA + paravertebral nerve block (Group C). Satisfaction with the surgical field, operation time, hospitalization duration, anesthesia costs, hospitalization costs, postoperative feeding time, and ambulation time were recorded. Intraoperative and postoperative adverse events, perioperative anesthesia-related parameters, hemodynamic variables at five time points [pre-intubation (T0), 3 min post-intubation (T1), at surgery initiation (T2), at surgery completion (T3), and post-extubation (T4)], and arterial blood gas (ABG) indices at four time points [pre-intubation (T0’), 3 min post-intubation (T1’), 45 min post-intubation (T2’), and 1 hour post-surgery (T3’)] were analyzed.

Results: Compared with Group A, Groups B and C presented significantly shorter postoperative feeding times, earlier ambulation, shorter hospitalization durations, and lower anesthesia/hospitalization costs (P<0.05). The incidence of postoperative cough, sore throat, and hoarseness was lower in Groups B and C than in Group A (P<0.05). Compared with those in Group A, the total intubation time, extubation time, and recovery time in Groups B and C were significantly shorter (P<0.05). At T1 and T4, the mean arterial pressure (MAP) and heart rate (HR) were lower in Groups B and C than in Group A (P<0.05). At T2 and T3, the end-tidal CO₂ pressure (P_ETCO₂) concentration in Groups B and C was higher than that in Group A (P<0.05). Compared with Group B, Group C presented a lower MAP at T1, T2, and T3 (P<0.05). At T2’, Groups B and C presented a lower pH and higher partial pressure of CO₂ (PaCO₂) than did Group A (P<0.05), whereas the partial pressure of O₂ (PaO₂) was higher in Groups B and C at T2’and T3’ (P<0.05).

Conclusions: Tubeless anesthesia with preserved spontaneous breathing is safe and effective in selected low-risk patients undergoing short-duration thoracoscopic wedge resection, reducing postoperative complications and promoting enhanced recovery.

Trial Registration: Chinese Clinical Trial Registry ChiCTR2300073484.

Keywords: Tubeless anesthesia; thoracoscopic wedge resection; enhanced recovery after surgery (ERAS)

 

Highlight box

Key findings

• Tubeless anesthesia can reduce postoperative complications and promote enhanced recovery, including earlier oral intake, earlier ambulation, shorter hospitalization, and reduced costs.

What is known and what is new?

• Tubeless anesthesia is feasible for minor thoracoscopic surgery.

• Tubeless anesthesia can reduce postoperative complications and promote enhanced recovery in selected low-risk patients undergoing short-duration thoracoscopic wedge resection.

What is the implication, and what should change now?

• Low-risk patients undergoing short-duration thoracoscopic wedge resection can choose tubeless anesthesia to obtain safe and comfortable medical treatment at lower costs.

Cite this article as: Li X, Guo S, Liang W, et al. Application of tubeless anesthesia for enhanced recovery after thoracoscopic wedge resection of the lung: a randomized trial. J Thorac Dis 2025;17(10):7924-7936. doi: 10.21037/jtd-2025-894