Objectives
The objective of this single-center, open, randomized control trial was to compare the patients’ satisfaction with local or general anaesthesia for video-assisted thoracoscopy (VATS).
Methods
Patients with indication for VATS pleural management, mediastinal biopsies or lung wedge resections were randomized for local or general anaesthesia. Local anaesthesia was administered along with no or mild sedation and no airway devices maintaining spontaneous breathing, general anaesthesia with double-lumen-tube and one-lung-ventilation. The primary end-point was anaesthesia-related satisfaction according to psychometrically validated questionnaires. Patients not willing to be randomized could attend based on their desired anaesthesia, forming the preference arm.
Results
Fifty patients were allocated to local anaesthesia, 57 patients to general anaesthesia. Age, smoking habits, and lung function were similarly distributed in both groups. There was no significant difference between the two groups regarding patient satisfaction with anaesthesiology care (median 2.75 vs 2.75, p = 0.74), general perioperative care (2.50 vs 2.50, p = 0.57), recovery after surgery (2.00 vs 2.00, p = 0.16, 3-point-Likert-scales). Surgeons and anaesthesiologists alike were less satisfied with feasibility (p < 0.01 each) with patients in local anaesthesia. Operation time, postoperative pain scales, delirium, and complication rate were similar in both groups. Local anaesthesia -patients had a significantly shorter stay in hospital (mean 3.9 vs 6.0 days, p < 0.01). Of 18 patients in the preference arm, 17 chose LA, resulting in similar satisfaction.
Conclusions
Patients were equally satisfied with both types of anaesthesia, regardless whether their type of anaesthesia was randomized or deliberately chosen. Local is as safe as general anaesthesia but correlated with shorter length of stay. Almost all patients of the preference arm chose local anaesthesia. Considering the benefits of local anaesthesia, it should be offered to patients as an equivalent alternative to GA whenever medically appropriate and feasible.
Background
The few existing studies on the accuracy of lung ultrasound in the detection of a postoperative pneumothorax after thoracic surgery differ in the sonographic technique and the inclusion criteria. Several conditions are considered unfavourable in the sonographic examination of the lung. We aim to test these conditions for their impact on the diagnostic accuracy of lung ultrasound.
Methods
We compared lung ultrasound and chest roentgenograms for the detection of a pneumothorax after lung-resecting surgery in two prospective trials (register ID DRKS00014557 and DRKS00020216). The ultrasound examiners and radiologists were blinded towards the corresponding findings. We performed posthoc subgroup analyses to determine the influence of various patient or surgery related conditions on the sensitivity and specificity of ultrasound in the detection of pneumothorax.
Results
We performed 340 examinations in 208 patients. The covariates were age, gender, body mass index, smoking status, severity of chronic obstructive pulmonary disease, previous ipsilateral operation or irradiation, thoracotomy, postoperative skin emphysema, indwelling chest tube and X-ray in supine position. In univariate analysis, an indwelling chest-tube was associated with a higher sensitivity (58%, p = 0.04), and a postoperative subcutaneous emphysema with a lower specificity (73% vs. 88%, p = 0.02). None of the other subgroups differed in sensitivity or specificity from the total population .
Conclusions
Most of the patient- or surgery related conditions usually considered unfavourable for lung ultrasound did not impair the sensitivity or specificity of lung ultrasound. Further studies should not excluce patients with these conditions, but test the accuracy under routine conditions.
Trial registration
DRKS, DRKS00014557, registered 06/09/2018, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014557 and DRKS00020216, registered 03/12/2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020216
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