Clinical Research Directory

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).

Comparison of the Efficacy and Safety of Intravenous Buprenorphine Administered Via PCA System Versus Oxycodone in the Management of Postoperative Pain After Video-Assisted Thoracoscopic Surgery

The goal of this clinical trial is to learn whether intravenous buprenorphine administered via a patient-controlled analgesia (PCA) system provides effective and safer postoperative pain control than intravenous oxycodone PCA in adults undergoing video-assisted thoracoscopic surgery (VATS). It will also evaluate the overall tolerability of buprenorphine in the early postoperative period and explore longer-term pain outcomes. The main questions it aims to answer are: Does buprenorphine PCA provide pain control that meets predefined targets during the first 48 hours after VATS (both at rest and during respiratory rehabilitation/mobilization), compared with oxycodone PCA? Does buprenorphine PCA reduce clinically relevant respiratory safety events (e.g., apnea or oxygen desaturation requiring intervention) and excessive sedation, compared with oxycodone PCA? What opioid-related adverse effects (e.g., nausea/vomiting, pruritus, constipation, hypotension) occur with buprenorphine PCA versus oxycodone PCA? Does buprenorphine PCA affect time to first patient-initiated analgesic demand and total opioid consumption within 48 hours? Does the choice of PCA opioid influence quality of recovery and the incidence of persistent postoperative pain at follow-up? Researchers will compare buprenorphine PCA to oxycodone PCA (both as part of standardized multimodal analgesia and perioperative care, including serratus anterior plane block) to determine whether buprenorphine provides non-inferior analgesia with a superior safety profile. Participants will: Be randomly assigned (double-blind) to receive buprenorphine PCA or oxycodone PCA for 48 hours after surgery, alongside standard multimodal analgesia Receive standardized general anesthesia for VATS with one-lung ventilation and an ultrasound-guided serratus anterior plane block at the end of surgery Have pain scores (NRS) recorded at multiple time points over 48 hours, at rest and during rehabilitation, and complete recovery questionnaires (QoR-15) early after surgery Be monitored regularly for vital signs, sedation level (RASS), respiratory events, and other adverse effects, with total opioid use recorded Provide satisfaction ratings at discharge and be followed after discharge to assess persistent postoperative pain/hyperalgesia at 1, 3, and 6 months