Abstract No. 632 A retrospective analysis of lidocaine with epinephrine versus lidocaine alone in the placement of chest ports: does the vasoconstrictive effect of epinephrine result in shorter procedure times?

Abstract

The vasoconstrictive effect of epinephrine makes it a theoretically useful addition to lidocaine in the placement of chest ports. Recently, there has been a national shortage of lidocaine with epinephrine (LE) resulting in the routine use of lidocaine without epinephrine (L) for port placement. Based on anecdotal evidence, this has resulted in increased procedural bleeding and longer procedure times. The goal of the current study is to retrospectively compare chest port procedure times in patients receiving LE versus L. A retrospective analysis of 139 patients undergoing chest port placement from January through July 2017 was performed. Patient demographics included gender, age and procedure indication. Technical variables included number of port lumens, port laterality, local anesthetic type, use of sharp versus blunt dissection and procedure time. Laboratory parameters included platelet and international normalized ratio. Primary outcome included mean procedure time in minutes. Secondary outcome included port removal secondary to infection and/or hematoma. Descriptive statistics in addition to student’s t-test for comparison of means was performed. 139 patients (33 men, 106 women, mean age 57.4 years) were analyzed. 77 (55.4%) patients had ports placed with LE; 62 (44.6%) with L. 3 ports (2.2%) were removed because of hematoma and/or infection. No significant difference in mean procedure time between the two groups (23.6 (SD 6.4) LE vs 25.1 (SD 10.4) L, P = 0.30) was observed. Among operators utilizing sharp dissection techniques, significant differences in mean procedure time were observed (19.2 (SD 4.3) LE vs 25.4 (SD 8.5) L, P = 0.02). No significant differences were observed in those operators utilizing blunt dissection techniques (24.5 (SD 6.4) LE vs 25.0 (SD 10.8) L, P = 0.74). No significant differences in procedural time or procedural complications were observed in patients receiving LE compared to L. Operators utilizing sharp dissection techniques may benefit from the use of LE for local anesthesia.