Stellate ganglion block for cough suppression during sequential bilateral non-intubated pulmonary metastasectomy

ABSTRACT

Intraoperative cough during lung manipulation limits non-intubated video-assisted thoracoscopic surgery (NIVATS) and may require conversion to general anaesthesia. We describe a case of a 17-year-old male undergoing staged bilateral non-intubated pulmonary metastasectomy, allowing intra-patient comparison of cough-suppression strategies. During the first (left) procedure, cough persisted despite thoracic epidural anaesthesia, dexmedetomidine, and nebulised lignocaine, requiring rescue phrenic nerve block and topical lignocaine for control. Three weeks later, the same procedure, using similar baseline techniques, supplemented by an ultrasound-guided stellate ganglion block (SGB), produced excellent operating conditions with no significant cough and no need for rescue measures. This case suggests SGB may help suppress cough response during NIVATS, though single-case evidence cannot establish direct causality.