Postoperative Pain After Single Port, Two Ports and Three Ports VATS Lobectomy

Pulmonary Hospital Zakopane

Status: Unknown

Conditions: Lung Cancer

Treatments: Diagnostic Test: pain intensity measured in VAS scale

Study type: Interventional

Funder types: Other

Identifiers

NCT03228056

PHZakopane

Details and patient eligibility

About

This single-center, prospective, randomized controlled trial was designed to assess and compare the postoperative pain after VATS lobectomy performed though one, two and three incisions. The primary outcome measure is pain intensity measured in VAS scale. The secondary outcome measure is cumulative morphine consumption up to 72 hours after surgery

Full description

The best VATS technique for lobectomy has not been well defined yet. Most of the authors describe the VATS approach to lobectomy via 2 to even 4 incisions. The final step in the evolution of the technique is the use of a single-port approach. If conventional multiportal VATS is superior to open thoracotomy by virtue of minimizing surgical access trauma, then further reduction in such access trauma should yield even greater benefits. Therefore, reducing the number of wounds from three or four to just one, should, in theory, lead to less pain, paresthesia, and morbidity as well as faster recovery. However, critics of the uniportal VATS approach may raise concerns about whether this most minimally invasive surgical approach for lung surgery may compromise safety and treatment efficacy. In addition, there's the concern about true invasiveness of the procedure. This prospective, randomized controlled trial was designed to compare the postoperative pain after VATS lobectomy performed through one, two and three incisions. The primary outcome measure is pain intensity measured in VAS scale. The secondary outcome measures are cumulative morphine consumption up to 72 hours after surgery in 4-hour intervals and dynamic spirometry (PEF, FEV1 and FVC) measured daily at the bedside up to 72 hours after surgery. All patients will receive the same regimen of postoperative analgesia based on thoracic epidural block, non-steroidal anti-inflammatory drugs and rescue doses of morphine in PCA system. The side effects and complications including atelectasis, pneumonia, atrial fibrillation, urine retention, hypotension, respiratory depression and sedation will be analysed.

Enrollment: 90 estimated patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

1. American Society of Anesthesiologists (ASA) physical status 1-3
2. undergo videothoracoscopic lung lobectomy
3. forced expiratory volume in 1 second (FEV1) >1,5 l/min
4. no contraindications for epidural anesthesia
5. ability to comprehend principles of VAS pain examination method and to communicate in accordance with them.

Exclusion criteria

1. prior to the study: contraindications for local anesthesia, ASA>3, FEV1<1,5 l/min, conditions disabling the patient from comprehending the principles of VAS pain examination, known allergy to used medications.
2. during the study: failure to place epidural catheter, decision to abandon lobar resection (e.g. in case of neoplastic dissemination), intraoperative conversion to thoracotomy, intraoperative anatomical obstacles to distribution of local anesthetics, conditions disabling the patient from pain evaluation by means of VAS method (e.g. postoperative delirium), necessity to administer other pharmaceuticals influencing pain perception (e.g. sedatives), necessity of mechanical ventilation, interruption of local anesthesia as a result of technical problems (e.g. damage or slippage of catheter).

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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90 participants in 3 patient groups

uniportal VATS lobectomy

Experimental group

Description:

* uniportal VATS lobectomy * thoracic epidural block (0.125% bupivacaine with epinephrine 1:50000, continuous infusion 3-4 ml/hour) * ketoprofene 100 mg i.v every 12 hours * paracetamol 1000 mg i.v every 8 hours * rescue doses of morphine in PCA system (bolus dose 2 mg i.v) * pain intensity measured in VAS scale

Treatment:

Diagnostic Test: pain intensity measured in VAS scale

two-ports VATS lobectomy

Active Comparator group

Description:

* two-ports VATS lobectomy * thoracic epidural block (0.125% bupivacaine with epinephrine 1:50000, continuous infusion 3-4 ml/hour) * ketoprofene 100 mg i.v every 12 hours * paracetamol 1000 mg i.v every 8 hours * rescue doses of morphine in PCA system (bolus dose 2 mg i.v) * pain intensity measured in VAS scale

Treatment:

Diagnostic Test: pain intensity measured in VAS scale

three-ports VATS lobectomy

Active Comparator group

Description:

* three-ports VATS lobectomy * thoracic epidural block (0.125% bupivacaine with epinephrine 1:50000, continuous infusion 3-4 ml/hour) * ketoprofene 100 mg i.v every 12 hours * paracetamol 1000 mg i.v every 8 hours * rescue doses of morphine in PCA system (bolus dose 2 mg i.v) * pain intensity measured in VAS scale

Treatment:

Diagnostic Test: pain intensity measured in VAS scale