1
|
Diao H, Xu L, Li X, Wang Y, Peng Z. Comparison Results of Three-Port Robot-Assisted and Uniportal Video-Assisted Lobectomy for Functional Recovery Index in the Treatment of Early Stage Non-small Cell Lung Cancer: A Propensity Score-Matched Analysis. Ann Surg Oncol 2024; 31:2470-2481. [PMID: 38105381 PMCID: PMC10908624 DOI: 10.1245/s10434-023-14767-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Minimally invasive lobectomy is the standard treatment for early stage non-small cell lung cancer (NSCLC). The aim of this study is to investigate postoperative recovery in a prospective trial of discharged patients with early stage non-small cell lung cancer undergoing robot-assisted thoracic surgery (RATS) versus uniportal video-assisted thoracic surgery (UVATS). PATIENTS AND METHODS This is a prospective and observational study. From 9 September 2022 to 1 July 2023, 178 patients diagnosed with NSCLC admitted to the Department of Thoracic Surgery of Shandong Provincial Hospital signed informed consent and underwent lobectomy by RATS and UVATS. The functional recovery index included MD Anderson Symptom Inventory, Christensen Fatigue Scale, EORTC QLQ-C30, and Leicester Cough Questionnaire. RESULTS After propensity score-matched analysis, each group included 42 cases. For the baseline characteristics of patients, operation time (p = 0.01) and length of stay (p = 0.04) were shorter in the RATS group. The number of lymph nodes resected in the RATS group was much more than in the UVATS group. According to our investigation, appetite loss, nausea, diarrhea, and cough severity after RATS were better than after UVATS. After the first week, pain severity degree of the RATS group was higher than UVATS, while there was no difference during the second and third week. The physical score of the RATS group was higher than the UVATS group (p = 0.04), according to the Leicester Cough Questionnaire. CONCLUSION RATS was associated with severe short-term postoperative pain but less postoperative complications.
Collapse
Affiliation(s)
- Haixiao Diao
- Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Lin Xu
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiao Li
- Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Yancheng Wang
- Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Zhongmin Peng
- Shandong Provincial Hospital, Shandong University, Jinan, China.
| |
Collapse
|
2
|
Chung HW, Chang H, Hong D, Yun HJ, Chung HS. Optimal ropivacaine concentration for ultrasound-guided erector spinae plane block in patients who underwent video-assisted thoracoscopic lobectomy surgery. Niger J Clin Pract 2023; 26:1139-1146. [PMID: 37635608 DOI: 10.4103/njcp.njcp_63_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background An ultrasound-guided erector spinae plane block (ESPB) has emerged as an effective way to control postoperative pain and may be a good alternative way to an epidural block. However, relevant research on the appropriate concentration of local anesthetics for an ESPB remains scarce. Aims This study aimed to investigate the optimal concentration of ropivacaine for an ESPB in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods A total of 68 patients who underwent a VATS lobectomy were enrolled. An ipsilateral ultrasound-guided ESPB was performed with three different ropivacaine concentrations as a local anesthetic: 0.189% (G1), 0.375% (G2), and 0.556% (G3). The total amount of perioperative remifentanil administered, patient-controlled analgesia (PCA) applied, and rescue drugs for postoperative analgesia during the 24 h after surgery were acquired, and numeric rating scale (NRS) scores were obtained. Results The total amount of intraoperative remifentanil administered was 7.20 ± 3.04 mcg/kg, 5.32 ± 2.70 mcg/kg, and 4.60 ± 1.75 in the G1, G2, and G3 groups, respectively. G2 and G3 had significantly lower amounts of remifentanil administered than the G1 group (P = 0.02 vs. G2; P = 0.003 vs. G3). The G3 group needed more inotropes than the G1 and G2 groups in the perioperative period (P = 0.045). The NRS scores, PCA, and rescue drug were not significantly different in the three groups. Conclusion The optimal concentration of ropivacaine recommended for an ESPB was 0.375%, which was effective in controlling pain and reducing the intraoperative opioid requirements with minimal adverse reactions such as hypotension.
Collapse
Affiliation(s)
- H W Chung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H Chang
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - D Hong
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H J Yun
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H S Chung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
3
|
Abdul Khader A, Pons A, Palmares A, Booth S, Smith A, Proli C, De Sousa P, Lim E. Outcomes of chest drain management using only air leak (without fluid) criteria for removal after general thoracic surgery-a drainology study. J Thorac Dis 2023; 15:3776-3782. [PMID: 37559627 PMCID: PMC10407534 DOI: 10.21037/jtd-22-1810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/25/2023] [Indexed: 08/11/2023]
Abstract
Background Chest drain management is a variable aspect of postoperative care in thoracic surgery, with different opinion for air and drain volume output. We aim to study if acceptable safety was maintained using air leak criteria alone. Methods A 9-year retrospective analysis of protocolised chest drain management using digital drain air leak cut off less than 20 mL/min for more than 6 h for drain removal in patients undergoing general thoracic surgery. We excluded patients if a chest drain was not required nor removed during admission or if patients underwent volume reduction or pneumonectomy. Withdrawal criteria were suspected bleeding or chylothorax. Postoperative films were reviewed to document post-drain removal pneumothorax, pleural effusion, and reintervention (drain re-insertion). Results Between 2012 and 2021, 1,187 patients had thoracic surgery under a single surgeon. Following exclusion and withdrawal criteria, 797 patients were left for analysis. The mean age [standard deviation (SD)] was 61 [16] years and 383 (48%) were male. Median [interquartile range (IQR)] duration of drain insertion was 1 [1-2] day with a median length of hospital stay of 4 [2-6] days. Post-drain removal pneumothorax was observed in 141 (17.7%), post-drain removal pleural effusion was observed in 75 (9.4%) and re-intervention (reinsertion of chest drain) required in 17 (2.1%). Conclusions Our results demonstrate acceptable levels of safety using digital assessment of air leak as the sole criteria for drain removal in selected patients after general thoracic surgery.
Collapse
Affiliation(s)
- Ashiq Abdul Khader
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Aina Pons
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Abigail Palmares
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Sarah Booth
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Alexander Smith
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Chiara Proli
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Paulo De Sousa
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Eric Lim
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
- Academic Division of Thoracic Surgery, Imperial College and The Royal Brompton Hospital, London, UK
| |
Collapse
|
4
|
Meta-Resolve of Risk Factors for Nosocomial Infection in Patients Undergoing Thoracic Surgery. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:2836014. [PMID: 36247850 PMCID: PMC9537004 DOI: 10.1155/2022/2836014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/04/2022] [Accepted: 09/10/2022] [Indexed: 01/26/2023]
Abstract
As we all know, various complications may occur after surgery, and postoperative bleeding and infection are the most common in clinical practice. Postoperative infection mainly manifests as abdominal abscess, peritonitis, and fungal infection. Thoracic surgery is a very common clinical operation. It can directly deal with the relevant lesions, so a better curative effect can usually be obtained. However, patients undergoing thoracic surgery are generally more severely ill, with low immune resistance, long duration, and complicated surgical treatment process. Therefore, the probability of nosocomial infection is high, and there are many risk factors for infection. After the occurrence of HAI, it not only increases the suffering and economic burden of patients and the workload of medical staff but also prolongs the hospitalization time of patients, reduces the turnover rate of hospital beds, causes unnecessary economic losses, and affects the social and economic benefits of hospitals. Based on this, this paper proposes to analyze the risk factors of nosocomial infection in patients undergoing thoracic surgery, so as to provide a reference for the prevention or control of nosocomial infection. This paper analyzes the actual situation of nosocomial infection in a city hospital and then uses meta-analysis to determine the factors of nosocomial infection from the perspective of relevant research literature. Meta-analysis results show that patients older than 60 years have twice the risk of postoperative infection compared with patients younger than 60 years.
Collapse
|
5
|
Liu W, Wang F, Luo T, Zhang H, Gao G, Liu T, Liu Y, Xu S. The effects of programmed intermittent paravertebral bolus infusion on postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery: A prospective, randomized, controlled study. J Cardiothorac Vasc Anesth 2022; 36:3637-3644. [DOI: 10.1053/j.jvca.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/26/2022] [Accepted: 05/03/2022] [Indexed: 11/12/2022]
|
6
|
Chang WK, Li YS, Wu HL, Tai YH, Lin SP, Chang KY. Group-based trajectory analysis of postoperative pain in epidural analgesia for video-assisted thoracoscopic surgery and risk factors of rebound pain. J Chin Med Assoc 2022; 85:216-221. [PMID: 34698693 DOI: 10.1097/jcma.0000000000000647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The current study aimed to investigate the patterns of postoperative pain trajectories over time and their associated risk factors in patients receiving video-assisted thoracoscopic surgery (VATS) and epidural analgesia (EA) for non-small cell lung cancer (NSCLC). METHODS This retrospective study was conducted at a tertiary medical center and included patients undergoing VATS for stage I NSCLC between 2011 and 2015. Maximal pain intensity was recorded daily during the first postoperative week. Group-based trajectory analysis was performed to categorize variations in pain scores over time. Associations between pain trajectory classification and amount of EA administered and length of hospital stay (LOS) after surgery were also evaluated. RESULTS A total of 635 patients with 4647 pain scores were included in the analysis, and 2 postoperative pain trajectory groups were identified: group 1, mild pain trajectory (78%); and group 2, rebound pain trajectory (22%). Risk factors for rebound pain trajectory were a surgical time longer than 3 hours (odds ratio [OR], 1.97; 95% CI, 1.27-3.07), female sex (OR, 1.62; 95% CI, 1.04-2.53), and higher pain score on postoperative day 0 (OR, 1.21; 95% CI, 1.08-1.36; linear effect). Although group 2 had a longer LOS (p < 0.001), they did not receive more EA than group 1 (p = 0.805). CONCLUSION Surgical time, sex, and pain intensity after surgery were major determinants of rebound pain trajectory, and more aggressive pain control strategies should be considered in high-risk patients.
Collapse
Affiliation(s)
- Wen-Kuei Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Shiuan Li
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsiang-Ling Wu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ying-Hsuan Tai
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Shih-Pin Lin
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kuang-Yi Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| |
Collapse
|
7
|
Zhang S, Han X, Zhou D, Sun M, Cang J, Miao C, Liang C. The effects of erector spinae plane block on perioperative opioid consumption and rehabilitation in video assisted thoracic surgery. BMC Anesthesiol 2021; 21:313. [PMID: 34893026 PMCID: PMC8662884 DOI: 10.1186/s12871-021-01536-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to determine whether ultrasound-guided continuous erector spinae plane block (ESPB) had an effect on opioid consumption and postoperative rehabilitation in patients undergoing video-assisted thoracic surgery (VATS). METHODS In this prospective study, 120 patients aged 20-70 years who underwent elective VATS were randomly allocated to one of three groups: group C (general anesthesia with patient-controlled intravenous analgesia [PCIA]), group T (general anesthesia with patient-controlled epidural analgesia [PCEA]), or group E (general anesthesia with continuous ESPB and PCIA). Perioperative opioid consumption, visual analog scale (VAS) scores, preoperative and postoperative Quality of Recovery-15 scores, and postoperative opioid-related adverse events were all assessed. RESULTS Intraoperative sufentanil consumption in groups T and E was significantly lower than that in group C (both P < 0.001), and the postoperative sufentanil consumption in group E was also significantly lower than that in group C (P = 0.001). Compared with group C, the VAS scores at rest or during coughing immediately out of the post-anesthesia care unit at 6 h, 12 h, and 24 h postoperatively were significantly lower in group T (P < 0.05). However, the VAS scores at rest at 6 h and 12 h postoperatively in group E were lower than those of group C (P < 0.05), but were significantly higher than those of group T at all study times (P < 0.05). CONCLUSION Ultrasound-guided continuous ESPB significantly reduced perioperative opioid consumption during VATS and improved postoperative rehabilitation. However, these effects were inferior to those of thoracic epidural anesthesia. TRIAL REGISTRATION The present study was prospectively registered at http://www.chictr.org/cn /(registration number: ChiCTR1900023050 ); registration date: May 82,019.
Collapse
Affiliation(s)
- Sen Zhang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Xiaodan Han
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Di Zhou
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Minli Sun
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jing Cang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Changhong Miao
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Chao Liang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| |
Collapse
|
8
|
Evaluation of the Postoperative Nursing Effect of Thoracic Surgery Assisted by Artificial Intelligence Robot. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:3941600. [PMID: 34867111 PMCID: PMC8610671 DOI: 10.1155/2021/3941600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/27/2021] [Indexed: 12/01/2022]
Abstract
In order to evaluate the postoperative nursing effect of artificial intelligence robot-assisted thoracic surgery, this study proposed the Da Vinci robot-assisted pulmonary lobotomy, from January to December 2014; 42 patients (15 males and 27 females, aged 33–69 years old) underwent lobectomy with the Da Vinci robot system in the chest hospital. A series of postoperative nursing was carried out. The surgical results showed that 42 patients with Da Vinci robot-assisted lobectomy had operation time of 62–225 min and blood loss of 70–300 mL. There was no intraoperative blood transfusion, the intraoperative central rate was maintained at 60–100 times/min, and the blood pressure was maintained at 90–140/60–90 mmHg. No patient was transferred to thoracotomy, and 2 patients were performed robotic wedge resection first, and then, robotic lobectomy was performed after malignant tumor was confirmed by freezing results, with relatively light postoperative pain, no infection, beautiful wound, and smooth recovery and discharge. Robot-assisted lobectomy is a new technique with advantages of less trauma, less pain, faster recovery, and safer and more thorough lymph node dissection.
Collapse
|
9
|
Tung J, Patel R, Rajwani T, Han S, Hanson N, Sternbach J, Hubka M. Feasibility and efficacy of cryoneurolysis analgesia in robotic-assisted thoracoscopic surgery (CARTS): a pilot study. J Robot Surg 2021; 16:597-600. [PMID: 34313948 DOI: 10.1007/s11701-021-01279-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
Opioid therapy has been the mainstay therapy of post-operative pain management in thoracic surgery patients. With the high incidence of chronic pain in thoracic surgery patients and adverse effects of opioids, we examined the safety and efficacy of cryoneurolysis as an adjunct for narcotic-free pain management in robotic-assisted thoracoscopic lobectomies. Ten consecutive patients undergoing robotic-assisted (DaVinci) pulmonary resection and cryoneurolysis were compared to ten patients managed without intraoperative cryoneurolysis. All patients received multimodal pain regimen including paravertebral blocks as per our institutional enhanced recovery pathway. Patients with chronic pain and chronic opioid use were excluded. We compared inpatient and outpatient opioid consumption measured in morphine equivalents (mme), incidence of opioid-free outpatient recovery, and adverse events. The two groups did not differ significantly in terms of baseline demographics. Both inpatient (88.13 vs 26.92 mme) and outpatient (118.5 vs 34.5 mme) use of narcotics were significantly lower in the cryoneurolysis group (p < 0.05) with seven of ten patients receiving cryoneurolysis able to recover without the use of opioids in the outpatient setting, compared to two in the control group. One patient reported post-operative neuralgia in each cryoneurolysis and control group. There were no readmissions in either group and mean length of stay was identical at 1.7 days in control group and 1.1 days in experimental group (p = 0.33). The use of intraoperative intercostal cryoneurolysis may safely reduce the utilization of outpatient opioids in patients undergoing robotic-assisted thoracoscopic surgery. A randomized controlled trial is warranted to validate these findings in a larger cohort of patients.
Collapse
Affiliation(s)
- Jivatesh Tung
- Virginia Mason Medical Center, Virginia Mason Hospital, Seattle, WA, USA.
| | - Rishi Patel
- Virginia Mason Medical Center, Virginia Mason Hospital, Seattle, WA, USA
| | - Taufiq Rajwani
- Virginia Mason Medical Center, Virginia Mason Hospital, Seattle, WA, USA
| | - Shiwei Han
- Virginia Mason Medical Center, Virginia Mason Hospital, Seattle, WA, USA
| | - Neil Hanson
- Virginia Mason Medical Center, Virginia Mason Hospital, Seattle, WA, USA
| | - Joel Sternbach
- Virginia Mason Medical Center, Virginia Mason Hospital, Seattle, WA, USA
| | - Michal Hubka
- Virginia Mason Medical Center, Virginia Mason Hospital, Seattle, WA, USA
| |
Collapse
|
10
|
Nobukuni K, Hatta M, Nakagaki T, Yoshino J, Obuchi T, Fujimura N. Retrolaminar versus epidural block for postoperative analgesia after minor video-assisted thoracic surgery: a retrospective, matched, non-inferiority study. J Thorac Dis 2021; 13:2758-2767. [PMID: 34164168 PMCID: PMC8182553 DOI: 10.21037/jtd-21-238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The role of thoracic epidural analgesia (TEA) for postoperative analgesia after video-assisted thoracic surgery (VATS) is still controversial. Some studies have reported the efficacy of ultrasound-guided retrolaminar block (RLB) for the postoperative management of pain after chest wall surgery. The purpose of this study was to compare the postoperative analgesic efficacy and adverse effects of ultrasound-guided RLB with those of TEA in patients undergoing minor VATS procedures. Methods A total of 192 relevant records of patients were enrolled in this study. We reviewed electronic medical records of patients undergoing minor VATS procedures under general anesthesia. The primary outcome was the median differences in the numerical rating scale (NRS) scores during rest between the groups at the morning of postoperative day 1 (POD 1m). A propensity-matched analysis incorporating preoperative variables was used to compare the efficacy of postoperative analgesia in two groups. Results Overall, 94 patients were identified for analysis. Propensity score matching resulted in 47 patients in each group. There were no significant differences in the NRS scores between the two groups. The median differences in NRS scores during rest between the two groups at POD 1m were under 1, which indicates non-inferiority of RLB. There were no significant differences in the incidence of adverse effects and rescue dose of analgesic consumption between the two groups. Conclusions The analgesic effects of continuous ultrasound-guided RLB were non inferior to those of TEA for minor VATS procedures.
Collapse
Affiliation(s)
- Keiko Nobukuni
- Department of Anesthesiology, St. Mary's Hospital, Our Lady of the Snow Social Medical Corporation, Kurume, Japan
| | - Mariko Hatta
- Department of Anesthesiology, St. Mary's Hospital, Our Lady of the Snow Social Medical Corporation, Kurume, Japan
| | - Toshiaki Nakagaki
- Department of Anesthesiology, St. Mary's Hospital, Our Lady of the Snow Social Medical Corporation, Kurume, Japan
| | - Jun Yoshino
- Department of Anesthesiology, St. Mary's Hospital, Our Lady of the Snow Social Medical Corporation, Kurume, Japan
| | - Toshiro Obuchi
- Department of Thoracic Surgery, St. Mary's Hospital, Our Lady of the Snow Social Medical Corporation, Kurume, Japan
| | - Naoyuki Fujimura
- Department of Anesthesiology, St. Mary's Hospital, Our Lady of the Snow Social Medical Corporation, Kurume, Japan
| |
Collapse
|
11
|
Nobel TB, Adusumilli PS, Molena D. Opioid use and abuse following video-assisted thoracic surgery (VATS) or thoracotomy lung cancer surgery. Transl Lung Cancer Res 2019; 8:S373-S377. [PMID: 32038918 DOI: 10.21037/tlcr.2019.05.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Tamar B Nobel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Prasad S Adusumilli
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniela Molena
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
12
|
Soultanis KM, Gonzalez-Rivas D. Devising the guidelines: the concept of uniportal video-assisted thoracoscopic surgery-incisions and anesthetic management. J Thorac Dis 2019; 11:S2053-S2061. [PMID: 31637038 DOI: 10.21037/jtd.2019.02.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Uniportal video-assisted thoracoscopic surgery (VATS) is an already established minimally invasive technique in the field of thoracic surgery. The feasibility, safety and efficacy of the technique are already well documented. Comparative studies and meta-analyses have shown a clear advantage over open surgery and other minimally invasive techniques in terms of pain, length of stay (LOS), chest drain duration and morbidity. It covers a broad spectrum of indications for both malignant and benign diseases, including pulmonary and mediastinal tumor resections, diaphragm procedures (plication), esophageal surgery and airway surgery (bronchial resections, carinal resections). Its swift and wide adoption has resulted into many variations, all of whom are common in the fact they utilize a single incision to enter the chest and conduct the planned procedure. With this article, we attempt to standardize the technique as to the incision and the anesthetic management.
Collapse
Affiliation(s)
- Konstantinos Marios Soultanis
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai 200433, China.,Thoracic Surgery Department, Hellenic Airforce General Hospital, Athens, Greece
| | - Diego Gonzalez-Rivas
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai 200433, China.,Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
| |
Collapse
|
13
|
Tseng WC, Lin WL, Lai HC, Huang TW, Chen PH, Wu ZF. Fentanyl-based intravenous patient-controlled analgesia with low dose of ketamine is not inferior to thoracic epidural analgesia for acute post-thoracotomy pain following video-assisted thoracic surgery: A randomized controlled study. Medicine (Baltimore) 2019; 98:e16403. [PMID: 31305450 PMCID: PMC6641791 DOI: 10.1097/md.0000000000016403] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Thoracic epidural analgesia is the preferred method for postoperative analgesia following thoracic surgery. However, intravenous patient-controlled analgesia (IVPCA) may be an effective alternative. This study was conducted because few scientific reports exist comparing fentanyl-based IVPCA including a low dose of ketamine (fk-IVPCA) with thoracic patient-controlled epidural analgesia (t-PCEA) for the treatment of postoperative pain after video-assisted thoracic surgery (VATS). METHODS This prospective, and randomized study included 70 patients randomized into fk-IVPCA and t-PCEA groups. Pain at rest and during movement, successful and unsuccessful triggers after pressing the PCA device button, the need for rescue analgesia, drug-related adverse events, and patient satisfaction were recorded for 48 hours postoperatively. RESULTS No significant differences in the intensity of pain at rest or during movement were observed between the 2 groups within 48 hours postoperatively. The number of unsuccessful PCA triggers in the t-PCEA group 0 to 4 hours after surgery was significantly higher than that in the fk-IVPCA group. However, the numbers of successful PCA triggers in the fk-IVPCA group at 4 to 12 and 0 to 24 hours after surgery were significantly higher than those in the t-PCEA group. The incidence of analgesic-related side effects and patient satisfaction were similar in both groups. CONCLUSIONS Compared with t-PCEA, the addition of a subanesthetic dose of ketamine to fentanyl-based IVPCA resulted in similar pain control after VATS with no increase in the incidence of drug-related adverse effects. The results confirm that both multimodal intravenous analgesia and epidural analgesia can provide sufficient pain control and are safe strategies for treating acute post-thoracotomy pain.
Collapse
Affiliation(s)
| | | | | | - Tsai-Wang Huang
- Division of Chest Surgery, Department of Surgery, Tri-Service General Hospital and National Defense Medical Center
| | - Pin-Hsuan Chen
- Department of Anesthesiology
- Graduate Institute of Public Health, National Defense Medical Center
| | - Zhi-Fu Wu
- Department of Anesthesiology
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan, R.O.C
| |
Collapse
|
14
|
Salter BS, Weiner MM, Mittnacht AJC. Building the Case for Interfascial Analgesia: Block by Block. J Cardiothorac Vasc Anesth 2019; 33:1954-1955. [PMID: 31060937 DOI: 10.1053/j.jvca.2019.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Benjamin S Salter
- Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Menachem M Weiner
- Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexander J C Mittnacht
- Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
15
|
Postoperative pain after lobectomy: robot-assisted, video-assisted and open thoracic surgery. J Robot Surg 2019; 14:131-136. [PMID: 30927155 DOI: 10.1007/s11701-019-00953-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/25/2019] [Indexed: 12/12/2022]
Abstract
Surgical resection is the optimal procedure for early stage non-small cell lung cancer (NSCLC). Open thoracotomy, video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS) are different surgical modalities with possible different outcomes. The aim of this study was to analyze differences in outcome with a focus on postoperative pain. Patients undergoing lobectomy at the Maasstad Hospital in 2015 and 2016 were included. Postoperative pain was scored according to the Numerical Rating Scale (NRS). Additionally, duration of chest tube drainage and thoracic epidural analgesia (TEA), hospital length of stay and type of surgery were assessed. Lobectomy was performed in 57 patients. There was no significant difference in type of surgery, age, gender, right-sided surgery, postoperative NRS scores, duration of chest tube drainage and epidural anesthesia, and hospital length of stay (p > 0.05). Operative time for RATS was significantly longer (p = 0.002). Postoperative pain scores and other outcomes did not differ between the three different modalities in surgery for NSCLC. In the future, more minimally invasive surgery will be used in pulmonary surgery with thoracotomy as a safe alternative in selected cases. Future studies have to demonstrate if RATS will overcome the differences concerning cost-effectiveness over VATS.
Collapse
|
16
|
Comacchio GM, Monaci N, Verderi E, Schiavon M, Rea F. Enhanced recovery after elective surgery for lung cancer patients: analysis of current pathways and perspectives. J Thorac Dis 2019; 11:S515-S522. [PMID: 31032070 DOI: 10.21037/jtd.2019.01.99] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The concept of enhanced recovery after surgery (ERAS), initially introduced in the field of colorectal surgery, has been developed in order to optimize the postoperative course. In recent years the number of authors analyzing the role of ERAS in lung cancer surgery is increasing, highlighting several interventions with positive effects on the postoperative course. Yet it is still difficult to draw definite conclusions and specific guidelines, as most of these studies largely differ for their methodological aspects and study populations. Herein we focus on the key elements of each single intervention, trying to identify what we can apply in a common pathway, and which aspects are still to be evaluated for the validation of an ERAS program.
Collapse
Affiliation(s)
- Giovanni Maria Comacchio
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Nicola Monaci
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Enrico Verderi
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| |
Collapse
|
17
|
Sztain JF, Gabriel RA, Said ET. Thoracic Epidurals are Associated With Decreased Opioid Consumption Compared to Surgical Infiltration of Liposomal Bupivacaine Following Video-Assisted Thoracoscopic Surgery for Lobectomy: A Retrospective Cohort Analysis. J Cardiothorac Vasc Anesth 2019; 33:694-698. [DOI: 10.1053/j.jvca.2018.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Indexed: 11/11/2022]
|
18
|
Gabriel RA, Swisher MW, Sztain JF, Furnish TJ, Ilfeld BM, Said ET. State of the art opioid-sparing strategies for post-operative pain in adult surgical patients. Expert Opin Pharmacother 2019; 20:949-961. [DOI: 10.1080/14656566.2019.1583743] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Rodney A. Gabriel
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA, USA
- Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Matthew W. Swisher
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Jacklynn F. Sztain
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA, USA
| | - Timothy J. Furnish
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA, USA
| | - Brian M. Ilfeld
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Engy T. Said
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA, USA
| |
Collapse
|
19
|
Umari M, Segat M, Lucangelo U. Epidural for mini-invasive thoracic surgery: do we need a sledgehammer to crack a nut? J Thorac Dis 2018; 10:S2223-S2224. [PMID: 30123569 DOI: 10.21037/jtd.2018.06.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Marzia Umari
- Department of Emergency, Urgent Care and Acceptance, Cattinara University Hospital, Trieste, Italy
| | - Matteo Segat
- Department of Emergency, Urgent Care and Acceptance, Cattinara University Hospital, Trieste, Italy
| | - Umberto Lucangelo
- Department of Emergency, Urgent Care and Acceptance, Cattinara University Hospital, Trieste, Italy
| |
Collapse
|
20
|
Kuroda H, Sakao Y. Analgesic management after thoracoscopic surgery: recent studies and our experience. J Thorac Dis 2018; 10:S1050-S1054. [PMID: 29849207 DOI: 10.21037/jtd.2018.04.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yukinori Sakao
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| |
Collapse
|
21
|
Santambrogio L, Musso V. VATS lobectomy: does surgical heterogeneity prevent evidence on pain control? J Thorac Dis 2018; 10:S1029-S1031. [PMID: 29849215 DOI: 10.21037/jtd.2018.03.189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Luigi Santambrogio
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico of Milan, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Valeria Musso
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico of Milan, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|