Effect of lidocaine cream analgesia for chest drain tube removal after video-assisted thoracoscopic surgery for lung cancer: a randomized clinical trial

Background and objectivesPain management makes an important contribution to good respiratory care and early recovery after thoracic surgery. Although the development of video-assisted thoracoscopic surgery (VATS) has led to improved patient outcomes, chest tube removal could be distressful experience for many patients. The aim of this trial was to test whether the addition of lidocaine cream would have a signiﬁcant impact on the pain treatment during chest tube removal from patients who had undergone VATS for lung cancer.MethodsThis clinical trial was a double-blind randomized study. Forty patients with histologically confirmed lung cancer amenable to lobectomy/segmentectomy were enrolled. All patients had standard perioperative care. Patients were randomly assigned to receive either epidural anesthesia plus placebo cream (placebo, Group P) or epidural anesthesia plus 7% lidocaine cream cutaneously around the chest tube insertion site and on the skin over the tube’s course 20 min (Group L) before chest drain removal.ResultsVisual analog scale (VAS) scores were higher in Group P (median 5, IQR, 3.25-8) than in Group L (median 2, IQR, 1-3). Pain intensities measured using a PainVision system were also higher in Group P (median 296.7, IQR, 216.9–563.5) than Group L (median 41.2, IQR, 11.8–97.0). VAS scores and the pain intensity associated with chest drain removal were significantly lower in Group L than Group P (p=0.0002 vs p<0.0001).ConclusionAnalgesia using lidocaine cream is a very simple way to reduce the pain of chest tube removal after VATS.Trial registration numberUMIN000013824.

Download Full-text

Cold therapy and respiratory relaxation exercise on pain and anxiety related to chest tube removal: A clinical trial

Iranian Journal of Nursing and Midwifery Research ◽

10.4103/ijnmr.ijnmr_228_19 ◽

2021 ◽

Vol 26 (1) ◽

pp. 54

Author(s):

Zahra Rooddehghan ◽

Zahra Sajedi-Monfared ◽

Hamid Haghani ◽

AliReza Bakhshandeh ◽

LayaSajedi Monfared

Keyword(s):

Clinical Trial ◽

Chest Tube ◽

Cold Therapy ◽

Tube Removal ◽

Chest Tube Removal ◽

Relaxation Exercise

Download Full-text

Analgesic Effectiveness of Perioperative Ultrasound-Guided Serratus Anterior Plane Block Combined with General Anesthesia in Patients Undergoing Video-Assisted Thoracoscopic Surgery: A Systematic Review and Meta-analysis

Pain Medicine ◽

10.1093/pm/pnaa125 ◽

2020 ◽

Vol 21 (10) ◽

pp. 2412-2422 ◽

Cited By ~ 1

Author(s):

Xiaofei Zhang ◽

Chao Zhang ◽

Xiaofeng Zhou ◽

Wei Chen ◽

Junhong Li ◽

...

Keyword(s):

General Anesthesia ◽

Postoperative Analgesia ◽

Thoracoscopic Surgery ◽

Ultrasound Guided ◽

Serratus Anterior ◽

Pain Scores ◽

Tube Removal ◽

Chest Tube Removal ◽

Anterior Plane ◽

Video Assisted Thoracoscopic Surgery

Abstract Objective To investigate whether perioperative ultrasound-guided serratus anterior plane block (SAPB) combined with general anesthesia is more effective and safer than current analgesic techniques for postoperative analgesia after video-assisted thoracoscopic surgery (VATS). Methods PubMed, the Cochrane Library, and EMBASE were searched for clinical trials published up to July 31, 2019. Outcomes, including operative duration, postoperative pain scores, postoperative analgesia use, patient satisfaction with analgesia, time to chest tube removal, length of stay, and adverse effects were analyzed. Results Four clinical trials, including 262 patients, met inclusion criteria. Ultrasound-guided SAPB reduced pain scores at zero, 15, 30, 45, and 60 minutes in the postoperative anesthesia care unit (all P < 0.05) and at one, two, six, 12, and 24 hours in the ward (all P < 0.001). Additionally, postoperatively, morphine consumption at 15 and 30 minutes, overall morphine consumption, and total consumption (morphine plus tramadol) were significantly lower in the SAPB cohort (P < 0.05). Similarly, postoperative tramadol consumption at one, two, six, 12, and 24 hours was also lower in this cohort (all P < 0.05). The postoperative consumption of fentanyl, tramadol, and total morphine in patient-controlled analgesia (PCA) at 24 hours was significantly reduced (P < 0.05). Moreover, SAPB provided better patient satisfaction with analgesia (P = 0.0038). However, no statistically significant difference was found in duration of operation, time to chest tube removal, length of stay, or side effects (all P > 0.05). Conclusions Perioperative ultrasound-guided SAPB combined with general anesthesia provided more effective postoperative analgesia after VATS. However, no significant advantage was found regarding side effects.

Download Full-text

Effect of Spiritual Care on Chest Tube Removal Anxiety and Pain in Heart Surgery in Muslim Patients (Shia and Sunni)

Journal of Pastoral Care & Counseling Advancing theory and professional practice through scholarly and reflective publications ◽

10.1177/1542305020948189 ◽

2020 ◽

Vol 74 (4) ◽

pp. 234-240

Author(s):

Hossin Fasihizadeh ◽

Khadijeh Nasiriani

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Nursing Care ◽

Spiritual Care ◽

Chest Tube ◽

Heart Surgery ◽

Tube Removal ◽

Chest Tube Removal ◽

Sunni Islam

The process of removal of a chest tube can cause pain and anxiety. Spiritual care can be considered as a component of nursing care, especially in the pain and anxiety relating to such procedures. This study was a randomized clinical trial. Eighty patients completed the study. The findings showed significant differences in anxiety and pain between groups ( p = 0.001). Spiritual care reduced anxiety and pain caused by chest tube removal in patients (Shia and Sunni Islam) undergoing heart surgery.

Download Full-text

Multicenter randomized study on comparison between electronic and traditional chest drainage systems

10.21203/rs.2.11716/v2 ◽

2019 ◽

Author(s):

Giuseppe Marulli ◽

Giovanni Maria Comacchio ◽

Mario Nosotti ◽

Lorenzo Rosso ◽

Paolo Mendogni ◽

...

Keyword(s):

Chest Tube ◽

Pleural Space ◽

Chest Drain ◽

Chest Drainage ◽

Drainage Systems ◽

Air Leaks ◽

Tube Removal ◽

Space Effect ◽

Digital Chest ◽

Chest Tube Removal

Abstract Background: In patients submitted to major pulmonary resection, post-operative length of stay is mainly influenced by duration of air leaks and chest tube removal. The measurement of air leaks largely relies on traditional chest drainage systems which are prone to subjective interpretation. Difficulty in differentiating between active air leaks and bubbles due to a pleural space effect may also lead to tentative drain clamping and prolonged time for chest drain removal. New digital systems allow continuous monitoring of air leaks, identifying subtle leakage that may be not visible during daily patient evaluation. Moreover, an objective assessment of air leaks may lead to a reduced interobserver variability and to an optimized timing of chest tube removal. Methods: This study is a prospective randomized, interventional, multicenter trial designed to compare the electronic chest drainage system (Drentech™ Palm Evo) with the traditional one (Drentech™ Compact) in a cohort of patients undergoing pulmonary lobectomy through a standard 3-ports VATS approach both for benign or malignant disease. It will enroll 382 patients in 3 Italian centers. Duration of chest drainage and length of hospital stay will be evaluated in the two groups. Moreover, it will be evaluated if the use of a digital chest system compared with a traditional system reduces theinterobserver variability. Finally, it will be evaluated if the digital drain system may help in distinguishing an active air leak from a pleural space effect, by the digital assessment of intrapleural differential pressure, and in identifying potential predictors of prolonged air leaks. Discussion : To date, few studies have been performed to evaluate clinical impact of digital drainage systems. The proposed prospective randomized trial will provide new knowledge to this research area by investigating and comparing the difference between digital and traditional chest drain systems. In particular, the objectives of this project are to evaluate the feasibility and usefulness of digital chest drainages and to provide new tools to identify patients at higher risk of developing prolonged air leaks.

Download Full-text

FP01.01 Uniportal Versus Multiportal Video-Assisted Thoracoscopic Surgery for Non-Small Cell Lung Cancer: An Updated Meta-Analysis

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2021.01.068 ◽

2021 ◽

Vol 16 (3) ◽

pp. S186

Author(s):

D. Magouliotis ◽

M. Fergadi ◽

K. Spiliopoulos ◽

K. Athanassiadi

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Thoracoscopic Surgery ◽

Meta Analysis ◽

Small Cell ◽

Small Cell Lung ◽

Video Assisted ◽

Video Assisted Thoracoscopic Surgery

Download Full-text

A six-week inspiratory muscle training and aerobic exercise improves respiratory muscle strength and exercise capacity in lung cancer patients after video-assisted thoracoscopic surgery: A randomized controlled trial

Clinical Rehabilitation ◽

10.1177/0269215520980138 ◽

2020 ◽

pp. 026921552098013

Author(s):

Jui-Fang Liu ◽

Nai-Ying Kuo ◽

Teng-Pei Fang ◽

Jui-O Chen ◽

Hung-I Lu ◽

...

Keyword(s):

Lung Cancer ◽

Aerobic Exercise ◽

Cancer Patients ◽

Thoracoscopic Surgery ◽

Inspiratory Muscle ◽

Inspiratory Muscle Training ◽

Muscle Training ◽

Lung Cancer Patients ◽

Lung Expansion ◽

Video Assisted Thoracoscopic Surgery

Objective: To compare the postoperative outcomes of inspiratory muscle training and aerobic exercise, along with standard care, on lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS). Design: A parallel-group, single-blind randomized clinical trial Setting: Thoracic surgery ward and outpatient clinic in a teaching hospital Subjects: Overall 63 patients underwent VATS were randomly assigned to a triaging (TG, n = 32) or control group (CG, n = 31). A total of 54 patients (TG, n = 26; CG, n = 28) completed the study. Intervention: TG: six-week threshold inspiratory muscle training and aerobic exercise. CG: standard care. Main measures: Maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) lung expansion volume, and 6-min walking test (6MWT) were performed on the day of chest tube removal (baseline), and 2, 6, and 12 weeks postoperatively. Results: The TG showed significant improvement in PImax at week 6 (71.6 ± 34.9 vs. 94.3 ± 32.8 cmH2O, P = 0.018), PEmax at week 2 (70.9 ± 24.3 vs. 90.9 ± 28.2 cmH2O, P = 0.015) and week 12 (76.1 ± 20.2 vs. 98.6 ± 35.3 cmH2O, P = 0.012), the lung expansion volume at week 2 (1080 ± 433 vs 1457 ± 624 mL, P = 0.02) and week 12 (1200 ± 387 vs 1885 ± 678 mL, P < 0.001), in addition to the 6MWT at week 2 (332 ± 78 vs 412 ± 74 m, P = 0.002), week 6 (360 ± 70 vs 419 ± 60 m, P = 0.007) and week 12 (360 ± 58 vs 402 ± 65 m, P = 0.036). Conclusion: A six weeks of inspiratory muscle training and aerobic exercise had improved respiratory muscle strength and aerobic exercise postoperatively in lung cancer patients after VATS as early as 2 weeks.

Download Full-text

Autologous Blood Pleurodesis: What Is the Optimal Time Interval and Amount of Blood?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1727129 ◽

2021 ◽

Author(s):

Alessio Campisi ◽

Andrea Dell'Amore ◽

Yonghui Zhang ◽

Zhitao Gu ◽

Angelo Paolo Ciarrocchi ◽

...

Keyword(s):

Chest Tube ◽

Autologous Blood ◽

Optimal Time ◽

Time Interval ◽

Air Leak ◽

Increased Risk ◽

Tube Removal ◽

Blood Patch ◽

Prolonged Air Leak ◽

Chest Tube Removal

Abstract Background Air leak is the most common complication after lung resection and leads to increased length of hospital (LOH) stay or patient discharge with a chest tube. Management by autologous blood patch pleurodesis (ABPP) is controversial because few studies exist, and the technique has yet to be standardized. Methods We retrospectively reviewed patients undergoing ABPP for prolonged air leak (PAL) following lobectomy in three centers, between January 2014 and December 2019. They were divided into two groups: Group A, 120 mL of blood infused; Group B, 60 mL. Propensity score-matched (PSM) analysis was performed, and 23 patients were included in each group. Numbers and success rates of blood patch, time to cessation of air leak, time to chest tube removal, reoperation, LOH, and complications were examined. Univariate and multivariate analysis of variables associated with an increased risk of air leak was performed. Results After the PSM, 120 mL of blood is statistically significant in reducing the number of days before chest tube removal after ABPP (2.78 vs. 4.35), LOH after ABPP (3.78 vs. 10.00), and LOH (8.78 vs. 15.17). Complications (0 vs. 4) and hours until air leak cessation (6.83 vs. 3.91, range 1–13) after ABPP were also statistically different (p < 0.05). Air leaks that persisted for up to 13 hours required another ABPP. No patient had re-operation or long-term complications related to pleurodesis. Conclusion In our experience, 120 mL is the optimal amount of blood and the procedure can be repeated every 24 hours with the chest tube clamped.

Download Full-text