Clinical Research Directory

Opioid Consumption After Thoracotomy and Factors Affecting Postoperative Acute Pain

Thoracic surgery operations constitute a significant portion of surgical procedures performed in hospitals. In the United States, more than 50,000 thoracic surgical procedures are performed annually, and more than 80% of these patients experience moderate to severe postoperative pain requiring opioid administration, which increases the risk of complications . It has also been reported that chronic pain develops in approximately 50% of patients after thoracic surgery . Thoracic surgery is commonly associated with severe, multifactorial pain during the postoperative period and is among the surgical branches with a high risk of developing chronic pain Despite advances in understanding postoperative pain mechanisms and improvements in pain management, inadequate postoperative pain control remains an unresolved healthcare problem. Higher acute pain scores are associated with less effective ventilation and coughing, increased incidence of lower respiratory tract infections, and prolonged ICU and hospital stays . In the management of acute postoperative pain after thoracic surgery, clinicians have sought alternatives to thoracic epidural analgesia to avoid its potential adverse effects. Truncal blocks such as thoracic paravertebral block, erector spinae plane block, and serratus anterior block have been used to reduce postoperative pain . Additionally, various other analgesic techniques such as patient-controlled analgesia (PCA) and multimodal analgesia have been employed. Historically, the cornerstone of acute postoperative pain control has been systemic opioids administered via oral, intravenous, or thoracic epidural routes . Although opioids provide excellent pain relief, they are associated with significant side effects that can adversely affect recovery . With the increasing use of ultrasonography (USG), truncal blocks have become more widespread. Alongside the development of Enhanced Recovery After Thoracic Surgery (ERATS) protocols, efforts have been made to reduce opioid use, leading to differing opinions regarding the management of acute pain after thoracic surgery. To prevent opioid use disorder and potential side effects, opioid-free or opioid-sparing approaches are now being encouraged in perioperative pain management . Conversely, some studies suggest that intraoperative opioid administration may have favorable effects on postoperative acute and chronic pain. Previous research has reported that the average daily opioid consumption after thoracic surgery is approximately 30 morphine milligram equivalents (MME) . Although video-assisted thoracoscopic surgery (VATS) has become more common, thoracotomy cases still constitute a large proportion of thoracic surgery procedures. Moreover, severe postoperative pain after thoracic surgery is most commonly associated with the thoracotomy incision itself. While some studies have suggested that new truncal block techniques may provide effective analgesia and reduce opioid consumption after thoracotomy, further studies are needed to determine which blocks are most commonly preferred and how opioid consumption patterns have changed with the adoption of these newer regional techniques. A review of the current literature reveals that the factors influencing acute pain after thoracotomy have not been sufficiently evaluated. Therefore, a re-evaluation of the factors affecting acute pain following thoracotomy, considering recent developments in pain management, is necessary. Furthermore, examining the relationship between perioperative opioid consumption, postoperative complications, and hospital length of stay in this patient population will provide valuable contributions to the literature. The aim of this study is to evaluate the amount of opioid consumption following thoracotomy and to investigate whether perioperative opioid use affects acute pain, postoperative complications, and the length of hospital stay.

Preoperative Nutritional Status and Postoperative Outcomes in Geriatric Lung Resection

Malnutrition is a common comorbidity in patients undergoing thoracic surgery. Furthermore, chronic diseases, polypharmacy, low nutrient intake, reduced appetite, and psychological factors-all frequently observed in geriatric patients-serve as risk factors for the development of nutritional deficiencies. Consequently, it is crucial to address the issue of malnutrition in geriatric patients-who often present with these risk factors-and to ensure that a nutritional status assessment is performed prior to thoracic surgery. While numerous screening tools are currently available to assess nutritional status in the elderly, there is no established "gold standard." Although it has been suggested that these nutritional screening tools can serve as prognostic indicators for geriatric surgical patients, the relationship between these tools and postoperative outcomes-such as pain, complications, and length of hospital stay-has not yet been fully evaluated in geriatric patients undergoing lung resection. This study aims to determine the relationship between preoperative nutritional status and postoperative outcomes in patients undergoing lung resection-an area lacking sufficient literature-and to investigate whether preoperative nutritional support can reduce postoperative complications in this patient population.Patients will undergo preoperative assessment, and data regarding those meeting inclusion criteria will be recorded. This includes routine blood tests, age, height, body weight, BMI, gender, diagnoses, ASA and ARISCAT scores, the surgery performed, durations of surgery/anesthesia/one-lung ventilation, intraoperative fluids and IV agents administered, fluid balance, any complications arising during the procedure or postoperative follow-up (up to discharge), Visual Analog Scale (VAS) scores at postoperative hours 1, 2, 4, 8, 16, and 24, Charlson Comorbidity Index, Clinical Frailty Scale (CFS), and nutritional status (GNRI, NRS-2002, PNI, MNA-SF). * Inclusion criteria: Patients undergoing elective thoracic surgery; patients undergoing lung resection via thoracotomy; patients who have provided informed consent; patients over 65 years of age; patients assessed as ASA class 1, 2, or 3; patients with a body mass index (BMI) between 18 and 35. * Exclusion criteria: Patients with ASA class IV or higher; patients scheduled for emergency surgery; patients under 65 years of age; patients with a history of prior thoracic surgery; patients in GOLD groups 3 or 4; patients with systemic inflammatory disease; patients with preoperative chronic pain who regularly use anti-inflammatories/analgesics; patients with a history of pulmonary thromboembolism (PTE).

Standalone Thoracoscopic Left Atrial Appendage Closure Versus Medical Therapy in Atrial Fibrillation

Surgical left atrial appendage closure (LAAC) has been associated with reduced rates of stroke in patients with atrial fibrillation (AF) who have undergone cardiac surgery. In recent time, procedures with catheter-based devices for LAAC have failed to achieve results that would make them considered a safe alternative to oral anticoagulation. Several concerns regarding catheter-based devices have been raised due to their contact with circulating blood, device migration and periprocedural complications. LAAC using an externally placed clip via thoracoscopy would elude some of these concerns and may therefore be a feasible alternative to oral anticoagulation in patients with AF. This study aims to assess whether thoracoscopic left atrial appendage closure (TLAAC) is noninferior to medical treatment in patients with AF and an elevated bleeding risk using or being planned to initiate OAC and in those patients with clinical contraindications to oral anticoagulants.

Comparison of Early Postoperative Functional Capacity and Kinesiophobia in Patients Undergoing Thoracic Surgery Via Thoracotomy or VATS

This observational cross-sectional study aims to compare early postoperative functional capacity and kinesiophobia in patients undergoing thoracic surgery via thoracotomy or video-assisted thoracic surgery (VATS). Patients aged 18-75 years who underwent thoracic surgery and agreed to participate will be evaluated during the early postoperative period, after chest tube removal and before hospital discharge. Functional capacity will be assessed using the 1-minute sit-to-stand test. Kinesiophobia will be evaluated using the Tampa Scale for Kinesiophobia. Pain, dyspnea, fatigue, and coronavirus-related anxiety will also be assessed using validated scales and questionnaires. The study will investigate the relationship between kinesiophobia and postoperative functional and symptom-related outcomes.

Effect of Two Different Plane Blocks on Post-thoracotomy Pain

Thoracotomy is recognized as one of the most painful surgical procedures. This increases the frequency of postoperative pulmonary complications. Erector Spinae Plane Block (ESPB) and Serratus Anterior Plane Block (SAPB) are more superficial, easier to perform, and less likely to have complications. In addition, ESPB and SAPB applications are increasing in patients who underwent thoracotomy and thoracoscopic surgery. In this study, the investigators aimed to evaluate the effect of continuous ESPB and continuous SAPB via US-guidance on post-thoracotomy pain.

Paravertebral Calcitonin in Thoracotomy

This prospective randomized double-blinded controlled study will be conducted to evaluate the effect of adding calcitonin to bupivacaine in thoracic paravertebral block for patients undergoing thoracotomy.

Different Approaches to Thoracic Paravertebral Block

Thoracic paravertebral block (TPB) in thoracic surgery is practiced since the development of minimally invasive surgery. Historically, thoracic epidural analgesia is done in open thoracic surgery. Thoracotomy with rib spacing causes strong post-operative pain that is well controlled with epidural analgesia and allows less use of morphine. However, this method causes frequent side effects. Minimally invasive surgery, when it is possible and recommended, has the main benefit of not spacing the ribs and therefore preventing nerve stretching, rib fractures and less post-operative pain. This less aggressive method has other benefits: less inflammation, better recuperation especially for vulnerable patients (the elderly; limited pulmonary functions), less time of thoracic drainage, less in hospital stay and better quality of life (1). Less invasive surgery has brought us to use less invasive analgesic methods. Thoracic paravertebral block is a good alternative to thoracic epidural analgesia but is unfortunately not done everywhere due to the lack and need of professional training. The objective of our study is to compare two methods of TPB: ultrasound guided method undergone by the anesthesiologist, and intrathoracic method undergone through video assisted surgery (VATS) or robotic assisted surgery (RATS).

Interscalene Block Versus Anterior Suprascapular Block for Post-Thoracotomy Shoulder Pain

This study aims to compare the frequency of occurrence of ipsilateral shoulder pain in patients undergoing thoracotomy with ultrasound-guided interscalene block, anterior suprascapular block as adjunct to epidural and epidural block only.

Costotransverse Foramen Block Versus Thoracic Paravertebral Block in Thoracotomy for Lung Cancer

This study aims to compare the costotransverse foramen block (CTFB) with thoracic paravertebral block (TPVB) in patients undergoing thoracotomy for lung cancer.

Awake Thoracic Epidural Anesthesia Versus General Anesthesia in Thoracotomy

This study aims to compare awake thoracic epidural anesthesia and general anesthesia in thoracotomy.

Incidence of Chronic Pain After Thoracic Surgery

Thoracotomy and video-assisted thoracic surgery procedures are frequently performed in thoracic surgery. It is widely accepted that thoracotomy causes severe acute pain. This prolongs the discharge time of the patients, and increases the frequency of postoperative pulmonary complications and postoperative morbidity. Postoperative acute pain may cause chronic thoracotomy pain in the later period, and may adversely affect the quality of life of the patients. Video-assisted thoracic surgery (VATS) has become the standard procedure in minor and major lung surgeries. Postoperative pain is seen in patients undergoing VATS, although it is not as severe as after thoracotomy. As in thoracotomy, this affects the postoperative pulmonary complications and the discharge time of the patients. Likewise, this pain can cause chronic pain. In this study, it was aimed to analyze the symptoms of chronic pain in the 3rd and 6th months postoperatively in patients who had undergone thoracic surgery.

Registry of the Spanish Society of Thoracic Surgery

ReSECT is a project promoted by the Spanish Society of Thoracic Surgery with the aim not only to become an indefinite, dynamic and inclusive registry, but also to establish a common structural framework for the development of future multicentre projects in the field of thoracic surgery in Spain. The goal of this nationwide prospective observational registry is: * To develop and validate forecasting tools based on powerful computational methods with the goal of assisting in decision-making and improving quality of care. * To evaluate the progressive implementation of certain surgical techniques that are on the rise, new technologies and future health programs. * To be aware of our results as specialty and professionals and to serve as a permanent benchmarking instrument in thoracic surgery. The first part of ReSECT, based on a personal registry design, will contemplate any thoracic surgical procedure performed by thoracic surgeons and residents in thoracic surgery in our country. Additionally, the Spanish thoracic surgery departments that voluntarily accept to collectively participate will contribute to specific surgical processes focused on certain procedures with specific objectives to be progressively implemented. The first and only surgical process implemented since the start of the ReSECT project will focus on patients to undergo anatomical lung resection with special interest in those cases whose reason for intervention was lung cancer. The main questions to answer in case of that first surgical process include: * What is the performance of current predictive models for perioperative and oncological outcomes in our country? * How could we modify previous predictive models to improve their performance? * What is the implementation of current guideline recommendations in our country and across institutions? * What is the potential impact of deviations from current recommendations? * What is my performance compared to the rest of the thoracic surgical departments in my country in terms of perioperative and oncological outcomes? ReSECT does not consider prespecified comparison groups of patients.