الفهرس 
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Abstract
Background: Pleural effusions are on the rise, medical thoracoscopy is becoming more common and becoming the first line in the diagnostic algorithm. These warrants optimizing the procedure for best outcomes and patient satisfaction. Chest tubes and the trocar cause significant intercostal nerve injury.
Various scores have been developed to assess pain intensity. However, they need discretion in their interpretation and use as their results vary according to pain type, the population being studied and the personnel using them. Chest pain is a multifactorial ailment that is influenced by a myriad of factors that need addressing to effectively control it. Multimodal analgesia should be the cornerstone in any invasive procedure.
Pain management in medical thoracoscopy is vital, especially with the population target in whom general anesthesia is becoming riskier because of the comorbidities and the age. Local measures of pain control are the logical direction for solving this issue.
Aim of the study: the aim was to evaluate the hypothesis that local anesthetic lidocaine can reduce the procedural pain during medical thoracoscopy and so decrease the need of systemic anesthetics with the accompanied increased risk.
Methods: thirty patients were recruited over a period of 6-month,sixteen were randomized to the saline group and fourteen to the lidocaine group. ICT was placed pre thoracoscopy to evacuate the chest cavity. This was followed by the medication instillation. Medical thoracoscopy ensued. VAS was obtained at different points before and after the procedure. The follow up stopped 2 hours after thoracoscopy completion.
Results: The primary outcome in the study was that of the VAS obtained for the pain levels perceived by patients during thoracoscopy, this was 57.4 mm in the placebo group and 49 mm in the lidocaine group, this is a treatment effect of -8.4 and significance of 0.487. The secondary outcome was that of the midazolam doses used. This was 2.6 mg in the placebo group and 2.3 mg in the lidocaine group, this is a treatment effect of -0.3 with a significance of 0.514.
The results obtained from this study favor the use of lidocaine as a preprocedural analgesic option, however; they did not reach statistical significance. The lack of statistical significance may be attributed to the small sample size and the possible confounding factors be it gender, age, psychological or situational factors.
Conclusion: This study does not support the use of intrapleural analgesia for the reduction of procedural pain during thoracoscopy. However, based on previous studies, pre procedural intrapleural analgesia with different modalities is an effective method in anaesthetizing the pleura.