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Huang Y, Chen M, Wu Z, Liu P, Zhang S, Chen C, Zheng B. Postoperative chronic operation-related symptoms after minimally invasive lung surgery: a prospective observational protocol. BMJ Open 2024; 14:e082412. [PMID: 39097304 PMCID: PMC11298735 DOI: 10.1136/bmjopen-2023-082412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 07/19/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION Significant numbers of patients undergoing minimally invasive lung surgery develop chronic symptoms such as chronic pain and chronic cough after surgery, which may lead to a reduced quality of life (QoL). Despite this, there remains a dearth of high-quality prospective studies on this topic. Therefore, our study aims to systematically investigate the incidence and progression of long-term chronic symptoms following minimally invasive lung surgery, as well as changes in patient's psychological status and long-term QoL. METHODS This is a single-centre, observational, prospective study that included patients with stage I non-small cell lung cancer or benign lesions. Prior to surgery, patients' baseline levels of chronic pain, chronic cough and sleep will be documented. Anxiety, depression and QoL assessments will be conducted using the Hospital Anxiety and Depression Scale (HADS) and the European Organisation for Research and Treatment of Cancer (EORTC) 30-item QoL Questionnaire (QLQ-C30). Following surgery, pain and cough will be evaluated during the initial 3 days using the Numeric Pain Rating Scale and Visual Analogue Scale score, with assessments performed thrice daily. Additionally, sleep status will be recorded daily during this period. Subsequently, postoperative chronic symptoms and QoL will be assessed at weeks 1, 2, 4, 12, 26 and 52. Chronic cough will be evaluated using the Leicester Cough Questionnaire, chronic pain will be assessed via the Brief Pain Inventory and McGill Pain Questionnaire while the EORTC QLQ-C30 questionnaire and HADS will provide continuous monitoring of QoL, anxiety and depression statuses. Data will also include the timing of chronic symptom onset, predisposing factors, as well as aggravating and relieving factors. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethics Committees of Fujian Medical University Union Hospital. The findings will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT06016881.
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Affiliation(s)
- Yizhou Huang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- National Key Clinical Specialty of Thoracic Surgery, China
| | - Maohui Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- National Key Clinical Specialty of Thoracic Surgery, China
| | - Zhihui Wu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- National Key Clinical Specialty of Thoracic Surgery, China
| | - Peichang Liu
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Shuliang Zhang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- National Key Clinical Specialty of Thoracic Surgery, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- National Key Clinical Specialty of Thoracic Surgery, China
| | - Bin Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
- National Key Clinical Specialty of Thoracic Surgery, China
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Kolashov A, Lotfi S, Spillner J, Shoaib M, Almaghrabi S, Hatam N, Haneya A, Zayat R, Khattab MA. Evaluation of myocardial work changes after lung resection-the significance of surgical approach: an echocardiographic comparison between VATS and thoracotomy. Gen Thorac Cardiovasc Surg 2024; 72:542-550. [PMID: 38253974 DOI: 10.1007/s11748-023-02005-7] [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: 10/25/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Considering the controversial benefits of video-assisted thoracoscopic surgery (VATS), we intended to evaluate the impact of surgical approach on cardiac function after lung resection using myocardial work analysis. METHODS Echocardiographic data of 48 patients (25 thoracotomy vs. 23 VATS) were retrospectively analyzed. All patients underwent transthoracic echocardiography (TTE) within 2 weeks before and after surgery, including two-dimensional speckle tracking and tissue Doppler imaging. RESULTS No notable changes in left ventricular (LV) function, assessed mainly using the LV global longitudinal strain (GLS), global myocardial work index (GMWI), and global work efficiency (GWE), were observed. Right ventricular (RV) TTE values, including tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (TASV), right ventricular global longitudinal strain (RVGLS), and RV free-wall GLS (RVFWGLS), indicated greater RV function impairment in the thoracotomy group than in the VATS group [TAPSE(mm) 17.90 ± 3.80 vs. 21.00 ± 3.48, p = 0.006; d = 0.84; TASV(cm/s): 12.40 ± 2.90 vs. 14.70 ± 2.40, p = 0.004, d = 0.86; RVGLS(%): - 16.00 ± 4.50 vs. - 19.40 ± 2.30, p = 0.012, d = 0.20; RVFWGLS(%): - 11.50 ± 8.50 vs. - 18.31 ± 5.40, p = 0.009, d = 0.59; respectively]. CONCLUSIONS Unlike RV function, LV function remained preserved after lung resection. The thoracotomy group exhibited greater RV function impairment than did the VATS group. Further studies should evaluate the long-term impact of surgical approach on cardiac function.
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Affiliation(s)
- Alish Kolashov
- Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Shahram Lotfi
- Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Jan Spillner
- Department of Thoracic Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Mohamed Shoaib
- Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Saif Almaghrabi
- Department of Cardiology, Maria-Hilf Hospital Daun, Daun, Germany
| | - Nima Hatam
- Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Assad Haneya
- Department of Cardiothoracic Surgery, Heart Center Trier, Barmherzigen Brüder Hospital Trier, Trier, Germany
| | - Rashad Zayat
- Department of Thoracic Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany.
- Department of Cardiothoracic Surgery, Heart Center Trier, Barmherzigen Brüder Hospital Trier, Trier, Germany.
| | - Mohammad Amen Khattab
- Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany
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Neuschmid MC, Ponholzer F, Ng C, Maier H, Dejaco H, Lucciarini P, Schneeberger S, Augustin F. Intercostal Catheters Reduce Long-Term Pain and Postoperative Opioid Consumption after VATS. J Clin Med 2024; 13:2842. [PMID: 38792384 PMCID: PMC11122185 DOI: 10.3390/jcm13102842] [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: 04/05/2024] [Revised: 04/25/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Pain after video-assisted thoracoscopic surgery (VATS) leads to impaired postoperative recovery, possible side effects of opioid usage, and higher rates of chronic post-surgery pain (CPSP). Nevertheless, guidelines on perioperative pain management for VATS patients are lacking. The aim of this study was to analyze the effectiveness of intercostal catheters in combination with a single shot intraoperative intercostal nerve block (SSINB) in comparison to SSINB alone with respect to opioid consumption and CPSP. Methods: Patients receiving an anatomic VATS resection between 2019 and 2022 for primary lung cancer were retrospectively analyzed. A total of 75 consecutive patients receiving an ICC and SSINB and 75 consecutive patients receiving only SSINB were included in our database. After enforcing the exclusion criteria (insufficient documentation, external follow-ups, or patients receiving opioids on a fixed schedule; n = 9) 141 patients remained for further analysis. Results: The ICC and No ICC cohort were comparable in age, gender distribution, tumor location and hospital stay. Patients in the ICC cohort showed significantly less opioid usage regarding the extent (4.48 ± 6.69 SD vs. 7.23 ± 7.55 SD mg, p = 0.023), duration (0.76 ± 0.97 SD vs. 1.26 ± 1.33 SD days, p = 0.012) and frequency (0.90 ± 1.34 SD vs. 1.45 ± 1.51 SD times, p = 0.023) in comparison to the No ICC group. During the first nine months of oncological follow-up assessments, no statistical difference was found in the rate of patients experiencing postoperative pain, although a trend towards less pain in the ICC cohort was found. One year after surgery, the ICC cohort expressed significantly less often pain (1.5 vs. 10.8%, p = 0.035). Conclusions: Placement of an ICC provides VATS patients with improved postoperative pain relief resulting in a reduced frequency of required opioid administration, less days with opioids, and a reduced total amount of opioids consumed. Furthermore, ICC patients have significantly lower rates of CPSP one year after surgery.
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Affiliation(s)
- Marie-Christin Neuschmid
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria (F.P.)
| | - Florian Ponholzer
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria (F.P.)
| | - Caecilia Ng
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria (F.P.)
| | - Herbert Maier
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria (F.P.)
| | - Hannes Dejaco
- Department of Anaesthesiology and Critical Care, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Paolo Lucciarini
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria (F.P.)
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria (F.P.)
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria (F.P.)
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Ponholzer F, Schweiger T, Ghanim B, Maier H, Hutter J, Tomaselli F, Krause A, Müller M, Lindenmann J, Spruk G, Augustin F. Analysis of Pain Management after Anatomic VATS Resection in Austrian Thoracic Surgery Units. J Clin Med 2023; 13:80. [PMID: 38202087 PMCID: PMC10779807 DOI: 10.3390/jcm13010080] [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: 11/06/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Postoperative pain influences rehabilitation, postoperative complications and quality of life. Despite its impact, there are no uniform treatment guidelines. Different centers seem to use various strategies. This study aims to analyze pain management regimens used after anatomic VATS resections in Austrian thoracic surgery units, with a special interest in opioid usage and strategies to avoid opioids. METHODS A questionnaire was designed to assess the use of regional anesthesia, postoperative pain medication and characteristics of individual pain management regimens. The questionnaire was sent to all thoracic surgery units in Austria, with nine out of twelve departments returning them. RESULTS All departments use regional anesthesia during the procedure. Four out of nine centers use epidural analgesia or an intercostal catheter for postoperative regional anesthesia in at least 50% of patients. Two departments follow an opioid restrictive regimen, five depend on the visual analogue scale (VAS) and two administer opioids on a fixed schedule. Three out of nine departments use NSAIDs on a fixed schedule. The most used medication is metamizole (eight out of nine centers; six on a fixed schedule, two depending on VAS) followed by piritramide (six out of nine centers; none as a fixed prescription). CONCLUSIONS This study reflects the heterogeneity in postoperative pain treatment after VATS anatomic lung resections. All departments use some form of regional anesthesia in the perioperative period; prolonged regional anesthesia is not utilized uniformly to reduce opioid consumption, as suggested in enhanced recovery after surgery programs. More evidence is needed to optimize and standardize postoperative pain treatment.
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Affiliation(s)
- Florian Ponholzer
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (H.M.)
| | - Thomas Schweiger
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Bahil Ghanim
- Department of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, 3500 Krems an der Donau, Austria;
| | - Herbert Maier
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (H.M.)
| | - Jörg Hutter
- Department of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Florian Tomaselli
- Department of Cardiac-, Vascular-, and Thoracic Surgery, Johannes Kepler University Linz, 4020 Linz, Austria
| | - Axel Krause
- Department of Surgery, Elisabethinen Hospital, 4020 Linz, Austria
| | - Michael Müller
- Department of Thoracic Surgery, Clinic Floridsdorf, 1210 Vienna, Austria;
| | - Jörg Lindenmann
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, 8010 Graz, Austria
| | - Gero Spruk
- Department of Cardiac-, Thoracic- and Vascular Surgery, Klinikum Klagenfurt am Wörthersee, 9020 Klagenfurt, Austria;
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (H.M.)
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Wu X, Chen H, Wang M, Wang P, Zhang Y, Wu Y. Rescue analgesia with serratus anterior plane block improved pain relief after thoracic surgery. Minerva Anestesiol 2023; 89:1082-1091. [PMID: 38019172 DOI: 10.23736/s0375-9393.23.17688-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) is frequently associated with substantial postoperative pain, which may lead to hypopnea. Rescue analgesia using opioids has adverse effects. We aimed to evaluate the effects of rescue analgesia with serratus anterior plane block (SAPB) on moderate-to-severe pain and oxygenation in patients undergoing VATS. METHODS Eighty patients undergoing VATS and reporting a numeric rating scale (NRS, ranging from 0-10) score of cough pain ≥4 on the first postoperative day were randomized to receive either sufentanil or SAPB for rescue analgesia. The primary outcome was the degree of relief in cough pain 30 min after rescue analgesia. Arterial oxygen pressure (PaO2), opioid consumption after rescue analgesia and the incidence of chronic pain were also assessed. RESULTS The NRS scores were significantly reduced after rescue analgesia in both groups (Ppaired <0.001). Notably, the degree of relief in cough pain was significantly higher in the SAPB group than that in the sufentanil group (medians [interquartiles]: -3 [-4, -2] vs. -2 [-3, -1], P<0.001). Moreover, patients receiving SAPB exhibited significantly higher PaO2 than those before receiving rescue analgesia (Ppaired=0.007). However, there were no significant differences in the PaO2 before and after receiving rescue analgesia in the sufentanil group. No significant differences in opioid consumption or the incidence of chronic pain were observed between groups. CONCLUSIONS Rescue analgesia with SAPB on the first postoperative day had a greater effect on pain relief and oxygenation after VATS. However, its long-term effect on chronic pain requires further research.
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Affiliation(s)
- Xinzhe Wu
- Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Hong Chen
- Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Min Wang
- Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Penglei Wang
- Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ye Zhang
- Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yun Wu
- Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China -
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Farkas A, Csókási T, Fabó C, Szabó Z, Lantos J, Pécsy B, Lázár G, Rárosi F, Kecskés L, Furák J. Chronic postoperative pain after non-intubated uniportal VATS lobectomy. Front Surg 2023; 10:1282937. [PMID: 38026483 PMCID: PMC10679439 DOI: 10.3389/fsurg.2023.1282937] [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: 08/25/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Patients undergoing thoracic surgery are at increased risk of developing, long-lasting pain. Beyond the non-surgical factors, the type of operation, including the number of incisions, and the anesthetic assessment seemed to be important factors, although some studies are controversial. The aim of our study was to examine the presence of chronic postoperative pain after non-intubated uniportal VATS lobectomy. We examined the difference between the intubated, relaxed and non-intubated spontaneous ventilation surgical approaches in patients who underwent video-assisted thoracoscopic (VATS) uniportal lobectomy. Methods Demographic and postoperative data were retrospectively collected and analyzed, focusing on the use of pain medications, in 67 patients of the 140 patients selected by propensity score matching who underwent intubated (iVATS) or non-intubated (NITS) uniportal VATS lobectomy. This study focused on the use of analgesic medications 3, 6, and 12 months after surgery. Results Thirty-five intubated and 32 non-intubated patients were compared. Although the analgesic consumption was nearly 2% higher among the iVATS patients during the follow-up period, there were no statistically significant differences at 3 months (15.6 vs. 17.1%) (p = 0.868), at 6 months (9.4 vs. 12.4%) (p = 0.785), and at 12 months (3.3 vs. 5.9%) (p = 0.633) between the NITS and iVATS groups, respectively. More female than male patients reported chronic pain, but the difference was not statistically significant (p = 0.616). Diabetes mellitus was a statistically significant cofactor associated with chronic pain (p = 0.03), while cardiac disease (p = 0.6), perioperative morbidity (p = 0.228), prolonged air leak (p = 0.057), and repeat drainage (p = 0.626) were not. Conclusion Our study suggests that after non-intubation VATS lobectomies, the postoperative pain was less at 3, 6, and 12 months in NITS patients compared to iVATS patients. The 2% difference was not significant, so it may not be appropriate to claim the advantages of NITS in terms of postoperative pain.
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Affiliation(s)
- Attila Farkas
- Department of Thoracic Surgery, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Tímea Csókási
- Department of Pulmonology, University of Szeged, Szeged, Hungary
| | - Csongor Fabó
- Department of Anesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Zsolt Szabó
- Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - Judit Lantos
- Department of Neurology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Balázs Pécsy
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Ferenc Rárosi
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - László Kecskés
- Department of Thoracic Surgery, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
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Guo Z, Zhong F, Shu H. Construction of a risk index system for the prediction of chronic post-surgical pain after video-assisted thoracic surgery for lung resection: A modified Delphi study. Glob Health Med 2023; 5:229-237. [PMID: 37655184 PMCID: PMC10461330 DOI: 10.35772/ghm.2023.01061] [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: 04/23/2023] [Revised: 05/24/2023] [Accepted: 06/11/2023] [Indexed: 09/02/2023]
Abstract
In the present study, several research methods were adopted, including literature retrieval, theoretical analysis, and qualitative research, and then the draft of the prognostic factors for the chronic post-surgical pain (CPSP) index system after video-assisted thoracoscopic surgery (VATS) for lung resection was constructed. A Delphi survey was used for the study of 24 experts in the field of pain from three different grade-A tertiary hospitals in Guangzhou, China. In the two rounds of survey, the experts rated these indicators for the importance and feasibility of measurement (round 1, n = 21 participants; round 2, n = 20). Finally, we calculated Kendall's W index as a measure of consensus. A general consensus was reached on predicting CPSP after VATS, consisting of 10 first-level domains and 64 second-level indicators, involving biological, psychological and social perspectives. This study provides a comprehensive draft of risk factors developed and identified by experts to inform research-based evidence on chronic pain. Increased clinical awareness and a full understanding of how to screen and identify people with CPSP problems may lead to earlier recognition of chronic pain and greater facilitation of professional prevention.
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Affiliation(s)
- Zhimin Guo
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Fei Zhong
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haihua Shu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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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.
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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
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9
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Gilson GF, Khandhar SJ. Opioid-sparing opportunities in the thoracic surgery pathway. J Thorac Dis 2023; 15:256-259. [PMID: 36910120 PMCID: PMC9992589 DOI: 10.21037/jtd-22-1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/24/2023] [Indexed: 02/07/2023]
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10
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Prevalence and Predictors of Chronic Postsurgical Pain After Video-Assisted Thoracoscopic Surgery: A Systematic Review and Meta-analysis. Pain Ther 2023; 12:117-139. [PMID: 36227420 PMCID: PMC9845490 DOI: 10.1007/s40122-022-00439-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/15/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Determining the prevalence of chronic postsurgical pain (CPSP) after video-assisted thoracoscopic surgery (VATS) and identifying CPSP predictors should improve the prognosis of patients undergoing VATS. Although several studies have investigated predictors of CPSP after VATS, there were significant dissimilarities in the findings due to the confounding of predictors. METHODS PubMed, Cochrane, MEDLINE, Web of Science, Chinese Biomedical Literature, and China National Knowledge Infrastructure databases were comprehensively searched using the Medical Subject Headings terms "pain, postoperative," "thoracic surgery, video-assisted," and all related free terms from inception until March 27, 2022. The Stata metaprop package was used to comprehensively analyze the incidence of CPSP following VATS. Furthermore, the pooled odds ratios (OR) or the standardized mean differences (SMD) and their corresponding 95% confidence intervals (95% CI) were calculated, and qualitative analyses were performed for predictors that could not be assessed quantitatively to evaluate the effects of the included risk factors on the occurrence of CPSP. Unadjusted odds ratios were utilized to consider the impact of non-significant estimates if the original study did not report them. RESULTS Of the 4302 studies, 183 were considered eligible, and 17 were finally included in this study. The overall incidence of CPSP after VATS was 35.3% (95% CI 27.1-43.5%). The qualitative synthesis results revealed that female sex, age, and acute postoperative pain were definite predictors of CPSP after VATS. The number of ports, operation time, duration of drainage, and insufficient analgesia were also considered predictors. Consistent, quantitative synthesis results also showed that the aforementioned predictors were closely related to the occurrence of CPSP after VATS. Only by quantitative analysis, postoperative chemotherapy and an educational level less than junior school were also risk factors for CPSP. Other predictors displayed no evidence or unclear evidence of association with CPSP after VATS. CONCLUSION This study preliminarily determined the incidence of CPSP after VATS based on the existing literature. Female sex, age, and acute pain were identified as risk factors for CPSP after VATS, and other potential risk factors were also identified and analyzed. However, as a result of the inclusion of retrospective studies and inevitable limitations in this systematic review and meta-analysis, the results of this study still need to be verified by large-scale prospective clinical studies. TRIAL REGISTRATION CRD42022323179.
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Wang L, Zhou J, Liu H, Xu H, Li H, Feng Y, Tian X. Lung cancer patients with positive programmed death-ligand 1 expression endure graver postoperative pain. Eur J Pain 2023; 27:248-256. [PMID: 36373199 DOI: 10.1002/ejp.2056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/23/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative pain after video-assisted thoracoscopic surgery (VATS) is common in lung cancer patients, and it is unclear whether cancer itself participates in pain regulation. Programmed cell death ligand-1 (PD-L1) expressed by tumours may be analgesic. Our study aimed to detect the association between PD-L1 and acute postoperative pain. METHODS We reviewed patients who underwent VATS for lung cancer with tumour PD-L1 expression analysed in our centre from Jan 2017 to Jul 2020. They were divided into PD-L1 (-) group and PD-L1 (+) group and were further divided into four subgroups according to opioids for postoperative analgesia: sufentanil PD-L1 (-), sufentanil PD-L1 (+), oxycodone PD-L1 (-), and oxycodone PD-L1 (+). We compared the numeric rating scale (NRS) for the first three postoperative days at rest or cough between groups. RESULTS A total of 369 patients (167 in PD-L1 (-) vs. 202 in PD-L1 (+)) were included. On the first postoperative day, NRS at cough in the PD-L1 (+) patients were higher than those in the PD-L1 (-) patients (2.91 ± 1.07 vs. 2.66 ± 1.01, p = 0.018). On the third day, NRS at cough in PD-L1 (+) patients was higher (2.50 ± 1.02 vs. 2.26 ± 1.09, p = 0.043). For patients with oxycodone, NRS was higher in PD-L1 (+) than in PD-L1 (-) (p = 0.041) at cough after surgery. In contrast, those with sufentanil did not significantly differ in NRS between groups. CONCLUSIONS Patients with PD-L1 (+) suffered graver pain in the early postoperative period after VATS for lung cancer compared with PD-L1 (-) on tumours. Analgesia with sufentanil seemed to overcome this effect better than oxycodone. SIGNIFICANCE We demonstrated that patients with positive programmed cell death ligand-1 (PD-L1) on tumours suffered graver pain in the early postoperative period after video-assisted thoracoscopic surgery for lung cancer and reacted differently with opioids. It might be beneficial to adjust analgesic protocols according to tumour PD-L1 expression for individualized postoperative pain management.
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Affiliation(s)
- Lu Wang
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Jian Zhou
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Huixin Liu
- Department of Academic Research, Peking University People's Hospital, Beijing, China
| | - Hao Xu
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Huifang Li
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Xue Tian
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
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Kong L, Gao L, Zhang H, Wang X, Zhang J. Does Preoperative Hookwire Localization Influence Postoperative Acute and Chronic Pain After Video-Assisted Thoracoscopic Surgery: A Prospective Cohort Study. J Pain Res 2023; 16:21-32. [PMID: 36636265 PMCID: PMC9830704 DOI: 10.2147/jpr.s387543] [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: 08/25/2022] [Accepted: 12/24/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose This study aimed to investigate whether preoperative computerized tomography-guided hookwire localization-associated pain could affect acute and chronic postsurgical pain (CPSP) in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods We enrolled 161 adult patients who underwent elective VATS; sixty-nine patients experienced hookwire localization (Group A) and 69 did not (Group B). Group A was further subdivided into the multiple localization group (n=35, Group Amultiple) and the single localization group (n=34, Group Asingle) according to the number of hookwires. The numerical rating scale (NRS) was used preoperatively, during recovery at the post-anesthesia care unit (PACU), and the first two days, 3 and 6 months postoperatively. Furthermore, multivariate regression analysis was used to identify the risk factors associated with CPSP. The postoperative adverse events, length of hospital stay, and satisfaction in pain management were also recorded. Results The incidence and severity of acute postoperative pain were similar between Group A and Group B (p > 0.05). The incidence (56.5% vs 30.4%, p = 0.002) and the NRS scores (2.0 [2.0-3.0] vs 1.0 [1.0-2.0], p = 0.011) for CPSP were significantly higher in Group A than in Group B at 3 months postoperatively. On subgroup analysis, compared with Group Asingle, the intensity of CPSP (2.0 [2.0-3.0] vs 2.0 [1.0-2.0], p = 0.005) in Group Amultiple was slightly higher at 3 months postoperatively. Conversely, the CPSP incidence (60.0% vs 29.4%, p = 0.011) was significantly higher at 6 months postoperatively in Group Amultiple. The multivariate regression analysis further validated hookwire localization as a risk factor for CPSP (odds ratio: 6.199, 95% confidence interval 2.049-18.749, p = 0.001). Patient satisfaction relating to pain management at 3 months postoperatively was lower in Group A (p = 0.034). Conclusion The preoperative pain stress of hookwire localization increased the incidence and intensity of CPSP rather than acute pain at 3 months postoperatively, especially in patients with multiple hookwires.
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Affiliation(s)
- Lingchao Kong
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Lingling Gao
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Hong Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Xin Wang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Correspondence: Jun Zhang, Department of Anesthesiology, Shanghai Cancer Center, Fudan University and Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong’An Road, Xuhui District, Shanghai, 200032, People’s Republic of China, Tel +86-21-64175590, Fax +86-21-64174774, Email
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Chen WC, Zhang LH, Bai YY, Liu YB, Liang JW, He HF. Nomogram prediction of chronic postsurgical pain in patients with lung adenocarcinoma after video-assisted thoracoscopic surgery: A prospective study. Front Surg 2022; 9:1004205. [PMID: 36439523 PMCID: PMC9681821 DOI: 10.3389/fsurg.2022.1004205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/24/2022] [Indexed: 09/13/2023] Open
Abstract
Chronic postsurgery pain (CPSP) refers to persistent or repeated pain around the incision after surgery. Different from acute postoperative pain, the persistence of CPSP seriously affects the quality of life of patients. CPSP has a considerable global impact due to large surgical volumes. Although the development of video-assisted thoracoscopy (VATS) has reduced the risk of CPSP, it still seriously affects patients' quality of life. Clinical recognition of CPSP at an early stage is limited; therefore, we aimed to develop and validate a nomogram to identify the significant predictive factors associated with CPSP after VATS in patients with lung adenocarcinoma. We screened 137 patients with invasive adenocarcinoma of the lung from among 312 patients undergoing VATS. In this prospective study, patients were divided into the CPSP (n = 52) and non-CPSP (n = 85) groups according to the occurrence of CPSP. Relevant information was collected 1 day before surgery and 1-3 days after surgery, and the occurrence of CPSP was followed up by telephone at 3 months after surgery. Data on clinical characteristics and peripheral blood leukocyte miRNAs were used to establish a nomogram for predicting CPSP using least absolute shrinkage and selection operator (LASSO) regression methods. The area under curve (AUC) was used to determine the recognition ability of the nomograms. The model was subjected to correction and decision curve analyses. Four variables-body mass index (BMI), history of chronic pain, miR 550a-3p, and visual analog scale (VAS) score on postoperative day 2 (VAS2d)-were selected according to LASSO regression to build the nomogram. The nomogram demonstrated adequate calibration and discrimination in the prediction model, with an AUC of 0.767 (95% confidence interval: 0.679-0.856). The calibration plot showed the best fit between model predictions and practical observations, suggesting that the use of the proposed nomogram to predict CPSP is beneficial. A nomogram consisting of BMI, history of chronic pain, miR 550a-3p, and VAS2d predicted the risk of CPSP after VATS in patients with lung adenocarcinoma.
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Affiliation(s)
| | | | | | | | - Jin-wei Liang
- Department of Anesthesiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - He-fan He
- Department of Anesthesiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
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Lu Y, Ding H, Shao C, Wang N, Shi J, Lian C, Wu J, Shangguan W. Effect of lidocaine perioperative infusion on chronic postsurgical pain in patients undergoing thoracoscopic radical pneumonectomy. BMC Anesthesiol 2022; 22:255. [PMID: 35945486 PMCID: PMC9361613 DOI: 10.1186/s12871-022-01795-2] [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: 11/01/2021] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thoracoscopic radical pneumonectomy is associated with a high incidence of postoperative chronic pain. Studies on the benefits of lidocaine intravenous infusion during the perioperative period were still controversial in thoracoscopic surgery. METHODS Sixty-four lung cancer patients scheduled for thoracoscopic radical pneumonectomy were randomly divided into two groups: normal saline group (control group) or lidocaine group. In the lidocaine group, 1.5 mg/kg lidocaine was administered during the anesthesia induction, and 2 mg·kg-1·h-1 lidocaine was continuously intravenous infused until the end of the surgery. After the surgery, a mixture of 2 μg/kg sufentanil and 10 mg/kg lidocaine was continuously intravenous infused by postoperative patient-controlled intravenous analgesia pump (100 ml). In the control group, the same volume of normal saline was administered according to the calculation of lidocaine during anesthesia induction, maintenance and postoperative patient-controlled intravenous analgesia. The primary outcome was the incidence of chronic postoperative pain at 3 months after the surgery. The secondary outcomes include the incidence of chronic postoperative pain at 6 months after the surgery; the effect of lidocaine on postoperative pain within the first 24 and 48 h; total amount of sufentanil administered during entire procedure and the number of PCA triggers within 48 h after surgery. RESULTS Compared with the control group, the incidence of chronic pain at 3 months after the surgery was significantly lower (13 cases, 46.4% vs. 6 cases, 20.7%, p < 0.05), but no significant difference at 6 months between two group. The cumulative dosage of sufentanil in perioperative period was significantly lower (149.64 ± 18.20 μg vs. 139.47 ± 16.75 μg) (p < 0.05), and the number of PCA triggers (8.21 ± 4.37 vs. 5.83 ± 4.12, p < 0.05) was significantly greater in the control group. The NRS pain scores at 24 h (1.68 ± 0.72 vs. 1.90 ± 0.86) and 48 h (1.21 ± 0.42 vs. 1.20 ± 0.41) after the operation were no significant difference. CONCLUSION Perioperative infusion lidocaine significantly reduced the number of PCA triggers and the incidence of chronic postoperative pain at 3 months after the thoracoscopic radical pneumonectomy. TRIAL REGISTRATION http://www.chictr.org.cn : ChiCTR1900024759, frist registration date 26/07/2019.
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Affiliation(s)
- Yi Lu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China
| | - Hehe Ding
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China.,Department of Anesthesiology, People's Hospital of Ruian, The Third Affiliated Hospital of Wenzhou Medical University, Ruian, 325200, Zhejiang, People's Republic of China
| | - Caiqun Shao
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China
| | - Ning Wang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China
| | - Junhua Shi
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China
| | - Chaohui Lian
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China
| | - Junzheng Wu
- Department of Anesthesia and Pediatrics, Cincinnati Children Hospital Medical Center, Cincinnati, OH, USA
| | - Wangning Shangguan
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China.
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Chen Z, Jiang L, Zheng H, Zhang W, Lv X, Abdellateef A. Early postoperative pain after subxiphoid uniportal thoracoscopic major lung resection: a prospective, single- blinded, randomized controlled trial. Interact Cardiovasc Thorac Surg 2022; 35:6586803. [PMID: 35579360 PMCID: PMC9245390 DOI: 10.1093/icvts/ivac133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/17/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Zhigang Chen
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Lei Jiang
- Thoracic Surgery Department, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Hua Zheng
- Thoracic Surgery Department, Second People's Hospital Jingdezhen, JiangXi 333000, China
| | - Wentian Zhang
- Thoracic Surgery Department, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Xin Lv
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Amr Abdellateef
- Thoracic Surgery Department, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.,Cardiothoracic Surgery Department, Mansoura University Hospital, Mansoura University School of Medicine, Mansoura, 35111, Egypt
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Sherazee EA, Chen SA, Li D, Li D, Frank P, Kiaii B. Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:167-176. [PMID: 35521910 DOI: 10.1177/15569845221091779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Elan A Sherazee
- Department of Surgery, 8789UC Davis Medical Center, Sacramento, CA, USA
| | - Sarah A Chen
- Division of Cardiac Surgery, 8789UC Davis Medical Center, Sacramento, CA, USA
| | - David Li
- Department of Anesthesiology and Pain Medicine, 8789UC Davis Medical Center, Sacramento, CA, USA
| | - David Li
- Department of Pharmacy Services, 8789UC Davis Medical Center, Sacramento, CA, USA
| | - Paul Frank
- Department of Anesthesiology and Pain Medicine, 8789UC Davis Medical Center, Sacramento, CA, USA
| | - Bob Kiaii
- Division of Cardiac Surgery, 8789UC Davis Medical Center, Sacramento, CA, USA
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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]
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Zhang Y, Zhou R, Hou B, Tang S, Hao J, Gu X, Ma Z, Zhang J. Incidence and risk factors for chronic postsurgical pain following video-assisted thoracoscopic surgery: a retrospective study. BMC Surg 2022; 22:76. [PMID: 35236334 PMCID: PMC8892711 DOI: 10.1186/s12893-022-01522-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/18/2022] [Indexed: 12/20/2022] Open
Abstract
Background Video-assisted thoracoscopic surgery (VATS) has been widely used as an alternative for thoracotomy, but the reported incidence of chronic postsurgical pain (CPSP) following VATS varied widely. The purpose of this study was to investigate the incidence and risk factors for CPSP after VATS. Methods We retrospectively collected preoperative demographic, anesthesiology, and surgical factors in a cohort of patients undergoing VATS between January 2018 and October 2020. Patients were interviewed via phone survey for pain intensity, and related medical treatment 3 months after VATS. Univariate and multivariate analysis were used to explore independent risk factors associated with CPSP. Results 2348 patients were included in our study. The incidence of CPSP after VATS were 43.99% (n = 1033 of 2348). Within those suffering CPSP, 14.71% (n = 152 of 1033) patients reported moderate or severe chronic pain. Only 15.23% (n = 23 of 152) patients with moderate to severe chronic pain sought active analgesic therapies. Age < 65 years (OR 1.278, 95% CI 1.057–1.546, P = 0.011), female (OR 1.597, 95% CI 1.344–1.898, P < 0.001), education level less than junior school (OR 1.295, 95% CI 1.090–1.538, P = 0.003), preoperative pain (OR 2.564, 95% CI 1.696–3.877, P < 0.001), consumption of rescue analgesia postoperative (OR 1.248, 95% CI 1.047–1.486, P = 0.013), consumption of sedative hypnotic postoperative (OR 2.035, 95% CI 1.159–3.574, P = 0.013), and history of postoperative wound infection (OR 5.949, 95% CI 3.153–11.223, P < 0.001) were independent risk factors for CPSP development. Conclusions CPSP remains a challenge in clinic because half of patients may develop CPSP after VATS. Trial registration Chinese Clinical Trial Registry (ChiCTR2100045765), 2021/04/24
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Affiliation(s)
- Yingying Zhang
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Rong Zhou
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Bailing Hou
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Suhong Tang
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Jing Hao
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Xiaoping Gu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Zhengliang Ma
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
| | - Juan Zhang
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
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Starke H, von Dossow V, Karsten J. Preoperative evaluation in thoracic surgery: limits of the patient's functional operability and consequence for perioperative anaesthesiologic management. Curr Opin Anaesthesiol 2022; 35:61-68. [PMID: 34860702 DOI: 10.1097/aco.0000000000001086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW Preoperative evaluation of older and more morbid patients in thoracic surgery is getting more advanced. In this context, early risk stratification has a crucial role for adequate informed decision-making, and thus for generating favourable effects of clinical outcome. RECENT FINDINGS Recent findings confirm that many risk factors impair mortality and morbidity beyond classical medical findings like results of lung function tests and values of the revised cardiac risk index. Especially results from holistic views on patients' functional status like frailty assessments are linked with long-term survival after lung resection. SUMMARY A comprehensive risk stratification by anaesthesiologists generates valuable guidance for the best strategy of clinical treatment. This includes preoperative, peri-operative and postoperative interventions, provided by interdisciplinary healthcare providers, resulting in an Early Risk Stratification and Strategy ('ERSAS') pathway.
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Affiliation(s)
- Henning Starke
- Institute of Anaesthesiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum
| | - Vera von Dossow
- Institute of Anaesthesiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum
| | - Jan Karsten
- Institute of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
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Zengin M, Sazak H, Baldemir R, Ulger G, Alagoz A. The Effect of Erector Spinae Plane Block and Combined Deep and Superficial Serratus Anterior Plane Block on Acute Pain After Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Study. J Cardiothorac Vasc Anesth 2022; 36:2991-2999. [DOI: 10.1053/j.jvca.2022.01.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/07/2022] [Accepted: 01/29/2022] [Indexed: 11/11/2022]
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