Musculoskeletal Signs Associated with Shoulder Pain in Patients Undergoing Video-Assisted Thoracoscopic Surgery

Musculoskeletal Disorders Related to Upper Limb Disability after One-Year Lung Cancer Resection

Lung resection represents the main curative treatment in lung cancer; however, this surgical process leads to several disorders in tissues and organs. Previous studies have reported cardiovascular, pulmonary, and muscular disturbances that affect the functional capacity of these patients in the short, mid, and long term. However, upper limb impairment has been scarcely explored in the long term, despite the relevance in the independence of the patients. The aim of this study was to characterize the upper limb impairment in survivors of lung cancer one year after pulmonary resection. In this observational trial, patients who underwent lung cancer surgery were compared to control, healthy subjects matched by age and gender. Upper limb musculoskeletal disorders (shoulder range of motion, pain pressure threshold, nerve-related symptoms) and functional capacity (upper limb exercise capacity) were evaluated one-year post-surgery. A total of 76 survivors of lung cancer and 74 healthy subjects were included in the study. Significant differences between groups were found for active shoulder mobility (p < 0.05), widespread hypersensitivity to mechanical pain (p < 0.001), mechanosensitivity of the neural tissue (p < 0.001), and upper limb exercise capacity (p < 0.001). Patients who undergo lung cancer surgery show upper limb musculoskeletal disorders and upper limb functional impairment after a one-year lung resection. This clinical condition could limit the functionality and quality of life of patients with lung cancer.

The Incidence of Winged Scapula after Thoracic Cancer Surgery: A Prospective Cohort Study

BACKGROUND

 Lung cancer is the leading cause of cancer-related deaths, and surgery is still the first treatment of choice in early and locally advanced cases. One of the iatrogenic complications is the serratus anterior palsy, which could lead to a winged scapula (WS). Unfortunately, the incidence of this deficit in thoracic surgery is unclear. Our primary aim was to determine the incidence of WS in lung cancer patients in a single-center experience.

METHODS

 We conducted a retrospective analysis of prospectively collected data with patients eligible for oncological thoracic surgery from March 2013 until January 2014. A physical evaluation of the WS was performed pre- and postoperatively, at the discharge and after 1 year of follow-up.

RESULTS

 A total of 485 patients were evaluated; 135 (27.8%) showed WS. Longer operative time (p < 0.0001), type of surgery (p < 0.0001), lymphadenectomy (p < 0.0001), and neoadjuvant treatment prior surgery (p = 0.0005) were significantly related to the WS injury. Multivariable analysis showed that type of surgery was significantly associated with WS (p < 0.0001). After 1 year, 41.6% still had WS.

CONCLUSION

 The incidence of WS was similar to the literature. As WS incidence is underdiagnosed, assessment and correct education about possible deficits or impairments should be improved. Moreover, when a minimally invasive approach is not planned, it is a good clinical practice to discuss surgical strategies with surgeons to reduce this deficit.

Agreement between face-to-face and tele-assessment of upper limb disability in lung cancer survivors during COVID-19 era

INTRODUCTION

Upper limb disability can limit the quality of life of lung cancer survivors. The COVID-19 era has required a finding of alternatives to attend the monitoring of presented disturbances with the minor risk of spread. Tele-assessment offers new possibilities for clinical assessment demonstrating good reliability compared to traditional face-to-face assessment in a variety of patients. No previous study has applied this type of assessment in lung cancer survivors. For this reason, the aim of this study was to evaluate the level of agreement between upper limb disability assessment using tele-assessment and the face-to-face method in lung cancer survivors.

METHODS

A reliability study was conducted with 20 lung cancer survivors recruited from the Oncological Radiotherapy Service of the "Hospital PTS" (Granada). Patients attended a session for clinical face-to-face and real-time online tele-assessment. The main outcome measurements of the study included upper limb function (shirt task) and musculoskeletal disturbances (active range of movement and trigger points), and these outcomes were recorded by two independent researchers.

RESULTS

The outcome measures showed good agreement between both assessments. The active range of movement presented heterogeneous results, being excellent reliability (ρ > 0.75) in extension, internal rotation, homolateral adduction, and contralateral abduction, good (0.4 < ρ < 0.75) for flexion, homolateral abduction, contralateral adduction and contralateral external rotation, and poor (ρ < 0.4) for homolateral external rotation. The measure evaluating upper limb function and trigger points show the highest interrater reliability with confidence interval lower limits ≥0.99.

DISCUSSION

The tele-assessment of upper limb function and musculoskeletal disorders of lung cancer survivors present a good interrater reliability compared to face-to-face assessment. It could be useful for monitoring the disability presented by cancer survivors whose access is difficult by the residential situation, physical limitations or the risk of COVID-19 spread.

Effect of Upper Arm Position Changes on the Occurrence of Ipsilateral Shoulder Pain After Single-Operator Port Thoracoscopy

Background

The aim of this study was to explore the factors associated with the occurrence of ISP after VATS to reduce the incidence of ISP and improve patients' quality of life.

Methods

The data of patients were collected between June 2020 and August 2020 in the Department of Lung Cancer Surgery, Tianjin Medical University General Hospital. The angle of upper arm was measured intraoperatively. The patient's postoperative shoulder function was quantified using the Constant-Murley shoulder function rating score. The proportional hazards model was applied to identify multiple influence factors.

Results

A total of 140 eligible patients met criteria. At postoperative day 3, only the age influenced patients' shoulder pain. At postoperative day 14, univariate and multivariate logistic regression analyses showed that age (odds ratio [OR]: 1.098 [1.046-1.152]; P < 0.001) and upper arm Angle A (OR: 1.064 [1.011-1.121]; P = 0.018) were independent risk factors for low shoulder function scores. However, height was its protective factor (OR: 0.923 [0.871-0.977]; P = 0.006). At postoperative day 42, univariate and multivariate logistic regression analyses showed that age (OR: 1.079 [1.036-1.124]; P < 0.001) was a risk factor for low shoulder function scores, and height (OR: 0.933 [0.886-0.983]; P = 0.009) was its protective factor. In contrast, upper arm Angle B was not statistically associated with low shoulder function scores (P>0.05). In addition, the reduction in ipsilateral Shoulder scores after surgery was higher in patients with more than 113° of angle A (P = 0.025).

Conclusion

ISP was closely related to the angle of anterior flexion of the upper arm on the patient's operative side intraoperatively. The increase in the degree of postoperative shoulder injury is more pronounced for an anterior flexion angle of >113°. Therefore, we recommend that the angle of anterior flexion of the upper extremity should be <113° intraoperatively.

Psychological distress prior to surgery is related to symptom burden and health status in lung cancer survivors

PURPOSE

Patients with lung cancer experience a variety of distressing symptoms which could adversely affect quality of life. The aim of this study was to determine whether psychological distress prior to surgery is associated to health status and symptom burden in lung cancer survivors.

METHODS

A longitudinal observational study with 1-year follow-up was carried out. Health status was measured by the WHO Disability Assessment Scale (WHO-DAS 2.0), the Euroqol-5 dimensions (EQ-5D) and the Pittsburgh Sleep Quality Index (PSQI). Symptoms severity included dyspnoea (Multidimensional Profile of Dyspnoea); pain (Brief Pain Inventory); fatigue (Fatigue Severity Scale); and cough (Leicester Cough Questionnaire).

RESULTS

One hundred seventy-four lung cancer patients were included. Patients in the group with psychological distress presented a worse self-perceived health status, functionality and sleep quality. The group with psychological distress also presented higher dyspnoea, fatigue and pain.

CONCLUSION

Patients with psychological distress prior surgery present with a greater symptom burden and a poorer self-perceived health status, lower functionality and sleep quality, than patients without distress 1 year after the lung resection.

The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial

Background

Although video-assisted thoracoscopic surgery (VATS) is increasingly used, the optimal analgesia strategy is still unknown. We explore the efficacy and safety of preemptive ultrasound-guided paravertebral block (PVB) combined with parecoxib during VATS.

Methods

Seventy-four patients were divided into two groups. PVBs were performed before anesthesia induction under real-time ultrasound guidance. Visual analog scale (VAS) score with coughing at 48 h after surgery, postoperative sufentanil consumption and level of sedation (LOS) at 1, 4, 8, 12, 24, and 48 h postoperatively, intraoperative hemodynamics, satisfaction scores of patients and surgeons, remedial measures, time to chest tube removed and mobilization, adverse effects and hospital stay length were recorded. We also recorded inflammatory markers, respiratory function and the prevalence of chronic pain after surgery.

Results

VAS scores at rest and with coughing during the first 24 h after surgery were significantly lower in the P group (P<0.05). Consumption of sevoflurane, remifentanil, and dexmedetomidine was all significantly reduced in the P group (P<0.05). The consumption of sufentanil within 48 h after surgery, time to first dose and total dose of rescue ketorolac was significantly lower in the P group (P<0.05). The FEV1/FVC ratio was significantly higher in the P group at 1 and 3 d after surgery (P<0.05). Times to chest tube removal and mobilization were significantly shorter in the P group (P<0.05). Compared with the C group, the level of both ACTH and cortisol was significantly reduced in the P group at 1 and 3 d after surgery (P<0.05).

Conclusion

PVB combined with parecoxib was associated with better pain relief, decreased sufentanil and ketorolac consumption, less hemodynamic instability, and a lower surgery-related stress response. However, the incidences of chronic pain 3 and 6 months after surgery and the risk of complication except urinary retention were not significantly different between groups.