Neoplasms

Respiratory Tract (Lung and Bronchial) Diseases

All Conditions

Symptoms and General Pathology

Musculoskeletal Diseases

Nervous System Diseases

Lung Neoplasms

Pain

Shoulder Pain

Arthralgia

Joint Diseases

Neurologic Manifestations

Modified lateral positioning. This will ensure less pressure and stretch on shoulder than standard lateral positioning.

Right before surgery, the patient are posistioned in lateral position with arm elevated (not more than 90 degree from torso). In the intervention, the arm will be lowered and placed in towards the torso for patients enrolled in the experimantal arm.

Modified lateral positioning.

Stein O Danielsen

Up to 85% experience shoulder pain after thoracic surgery, especially on the same side as surgery are performed. Referred phrenic nerve pain is probably one cause of ipsilateral shoulder pain (ISP), and positioning of the arm during surgery another. Studies indicates that ISP can be caused by the positioning of the patient during surgery due to muscle -and ligament strain. Can a change in the surgical positioning (less press and stretch) of the ipsilateral arm effect the shoulder pain after thoracic surgery?

Surgical Positioning of the Arm During Thoracic Surgery -Effect on Shoulder Pain After Surgery?

Lateral Surgical Positioning for Thoracic Surgery -Effect on Ipsilateral Shoulder Pain?

Using visual analog scale for assesing pain in the shoulder (Scale from 0-10). Mesauring times: VAS pain related to the shoulder before surgery, VAS pain shoulder at day 1 and 3 after surgery. Further will Oslo University Hospital scheme for registration of pain for location and characteristic also be used.

All extra pain medication patient use after surgery until day 4, type and dose, will be mesaured.

Mesaured before surgery, and at day 1 and 3 after surgery.

Measured before surgery, and at day 1 and 3 after surgery.

Oslo University Hospital

RN, MNSc

Adjuvants, Anesthesia

Analgesics

Central Nervous System Depressants

All Drugs and Chemicals

Fentanyl

Bupivacaine

The ultrasound (US) guided ESPB was performed under aseptic conditions at the level of T5 vertebrae using the GE Vivid Q® US device. A high frequency 12 MHz linear US probe was covered with a sterile sheath and placed longitudinally 2-3 cm lateral to the T5 transvers process. After visualizing trapezius, rhomboid major, erector spinae muscles superficial to the hyperechoic transverse process shadow respectively, a 22-gauge 50 mm block needle (Braun Stimuplex Ultra 360, Germany) was inserted in a cephalad to caudad direction. Once the needle tip had been placed within the interfacial plane below the erector spinae muscle, 2 mL of saline were injected to confirm the proper injection site, and then a 20 mL dose of 0.25% bupivacaine was injected. Patients received fentanyl via a patient controlled analgesia (PCA) device with a protocol of 2 mL (10 µg/mL) bolus without an infusion dose, 20 min lockout time and 4 hour limit

Patients in control group only received fentanyl via a patient controlled analgesia (PCA) device with a protocol of 2 mL (10 µg/mL) bolus without an infusion dose, 20 min lockout time and 4 hour limit.

Erector spinae plane block was performed to the patients under aseptic conditions

Erector spinae plane block

Video assisted thoracic surgery (VATS) has recently been evaluated as the standard surgical procedure for lung surgery. Although VATS is less painful than thoracotomy, patients may feel severe pain during the first hours at postoperative period. Analgesia management is very important for these patients in postoperative period since insufficient analgesia can cause pulmonary complications such as atelectasis, pneumonia and increased oxygen consumption. The ultrasound (US) guided erector spina plane (ESP) block is a novel interfacial plan block defined by Forero et al. at 2016. ESP block provides thoracic analgesia at T5 level and abdominal analgesia at T7-9 level. Visualization of sonoanatomy with US is easy, and the spread of local anesthesic agents can be easily seen under the erector spinae muscle. Thus, analgesia occurs in several dermatomes with cephalad-caudad way. In the literature, there is not still any randomized study evaluating ESP block efficiency for postoperative analgesia management after VATS. The aim of this study is to evaluate US-guided ESP block for postoperative analgesia management after VATS.

Postoperative pain after thoracic surgery which is attributed to muscle incision, rib retraction, and intercostal nerve damage may be severe such a degree that it may cause pulmonary complications such as atelectasis, pneumonia and increased oxygen consumption. Because video assisted thoracic surgery (VATS) has some advantages over open thoracotomy such as reduced pain, shoulder dysfunction, early pulmonary impairment, rapid recovery, short hospital stay and low complication risk, it has recently been evaluated as the standard surgical procedure for lung surgery. Although VATS is a less painful procedure than open thoracotomy, patients may still feel severe pain during the first hours at postoperative period. As thoracic epidural analgesia (TEA) is the gold standard analgesic technique after thoracotomy, it is also being used for analgesia management following VATS. Hence TEA has some difficulties in administration and side effects, minimally invasive analgesic techniques are supported for pain management in patients who underwent VATS. The gold standard minimal invasive analgesic technique for VATS is still be questioned. Thoracic paravertebral block (TPVB) has been evaluated as the first step regional analgesia technique after VATS. However, its administration is difficult because of its anatomical proximity to important structures such as the pleura and central neuro-axial system. Therefore it may cause complications such as pneumothorax and neuro-axial injury. The ultrasound (US) guided erector spina plane block (ESPB) - a novel interfacial plan block defined by Forero et al. in 2016 - has the advantage of being away from the pleural and neurological structures, thus the risk of complications is lower. In the literature, case reports about the analgesic effect of ESPB after thoracotomy and VATS has been increasing. However there is no randomized study for VATS yet. In this study, investigators aimed to evaluate the efficacy of US-guided ESPB for postoperative analgesia management following VATS.

Postoperative pain assessment was performed by a anesthetists blinded to the procedure.

Erector Spinae Plane Block for Postoperative Analgesia Management Following Video Assisted Thoracic Surgery

The Efficacy of Ultrasound-guided Erector Spinae Plane Block for Postoperative Analgesia Management Following Video Assisted Thoracic Surgery: A Prospective, Randomized Study

individual participant data (IPD) will not be shared

All patients received fentanyl via a patient controlled analgesia (PCA) device.

0 = no pain, 10 = the most severe pain felt

Medipol University

Principal Investigator

Respiratory Tract Neoplasms

Thoracic Neoplasms

Lung Diseases

Respiratory Tract Diseases

Participants will undergo robotic assisted thoracic surgery (RATS) for segmentectomy or lobectomy.

Participants will undergo video assisted thoracic surgery (VATS) for segmentectomy or lobectomy.

Surgeons will pre-determine to perform a segmentectomy or lobectomy using RATS.

Robotic Assisted Thoracic Surgery

Surgeons will pre-determine to perform a segmentectomy or lobectomy using VATS.

Video Assisted Thoracic Surgery

Varsha Gandhi

James Grainger

Tom Routledge

Rune Eggum

Martin Eichhorn

To compare outcomes of minimally invasive surgical techniques for the treatment of early-stage non-small cell lung cancer.

Detection of lung cancer is occurring at increasingly earlier stages due to improved screening and the discovery of incidental nodules. Coinciding with this trend is recent data from two international randomized, control trials, RAVAL - (Robotic Lobectomy vs. Thoracoscopic Lobectomy for Early Stage Lung Cancer) and, JCOG0802 (The Japan Clinical Oncology Group) that show oncologic outcomes from segmentectomy are equivalent to lobectomy for cancers ≤2 cm. However, segmentectomy is a more complex technical operation that may not be easily feasible using video assisted thoracic surgery (VATS) but could be facilitated by robotic-assisted thoracic surgery (RATS), allowing improved vision, precision and controlled anatomic dissection.

The LARCS study is designed to understand the perioperative outcomes of patients and identify the real-world selection process of either VATS and RATS segmentectomy and lobectomy for lung cancers ≤2 cm. It aims to generate evidence to support integration of patient-centered care using minimally invasive technology.

In addition, health related quality of life captured in the study will also provide valuable insight into time to recovery, determining burden of the disease, and guide future treatment strategy.

Lung cAncer Robotic Comparative Study

Comparing Outcomes for Minimally Invasive Techniques for Anatomic Lung Resection for Cancer - A Prospective, Comparative, Non-randomized, Open Label Post-market Observational Cohort Study Within Europe

EQ 5D 5L (European Quality of Life Five Dimension) The EQ-5D-5L is a validated and established generic Patient Reported Outcome (PRO) instrument that uses 6 questions to assess patients' quality of life. It includes a vertical EQ visual analog scale (EQ VAS, 0-100 points) and a descriptive EQ-5D-5L system. An algorithm is used to calculate the scores.

For the descriptive section of the scale, an index value of 1 represents the best possible health state, while an index value of \<0 (variable) represents the worst possible health state.

The EQ VAS score is rated on a scale of 0-100 points. 0 points correspond to the worst possible health status, while 100 points correspond to the best possible health status.

RNLI (Reintegration to Normal Living Index) The RNLI has 11 questions and is scored on a visual analogue scale (VAS). On one end: "does not describe my situation" (1 or minimal integration) and "fully describes my situation" (10 or complete integration). Individual item scores are summed to provide the total score. The higher the score, the better the patients perceived integration.

Number of participants who undergo conversion surgery from the pre-operative surgical plan captured on the surgical decision making form. Conversion may be from segmentectomy to lobetomy, RATS or VATS to open surgery.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Surgical Positioning of the Arm During Thoracic Surgery -Effect on Shoulder Pain After Surgery?	NCT02149849	Lung Cancer	Modified latera...	18 Years -	Oslo University Hospital
Erector Spinae Plane Block for Postoperative Analgesia Management Following Video Assisted Thoracic Surgery	NCT03879148	Lung Cancer	Erector spinae ...	18 Years - 65 Years	Medipol University
Surgical Positioning of the Arm During Thoracic Surgery -Effect on Shoulder Pain After Surgery?	NCT02149849	Lung Cancer	Modified latera...	18 Years -	Oslo University Hospital
Lung cAncer Robotic Comparative Study	NCT06038227	Lung Cancer	Robotic Assiste... Video Assisted ...	18 Years -	Intuitive Surgical

Spots Global Cancer Trial Database for video assisted thoracic surgery