Purpose
Thoracic paravertebral block (TPVB) is a recommended regional analgesia during video-assisted thoracoscopic surgery (VATS). However, single-injection TPVB does not last long enough to provide sufficient acute postoperative pain relief. Continuous TPVB through a catheter is technically challenging and often unreliable. Intravenous dexamethasone extends the analgesic duration with some peripheral nerve blocks. However, data on the effect of intravenous dexamethasone on pain relief with TPVB are limited. This study aimed to assess the analgesic efficacy of intravenous dexamethasone in patients who received TPVB for VATS.
Patients and Methods
In this multicenter prospective randomized controlled trial, we recruited patients aged between 18 and 80 years with the American Society of Anesthesiologists of physical status class 1–3 and underwent elective VATS. Patients under general anesthesia randomly received 8 mg of intravenous dexamethasone (group D) or normal saline (group C). Ultrasound-guided TPVB (USG-TPVB) was performed at the T4–T5 and T6-T7 spaces. Multimodal analgesia was achieved via paracetamol, tramadol and intravenous morphine for both study groups. The primary outcome was time for the first analgesic requirement. Postoperative pain in terms of numeric rating score (NRS), total morphine consumption and postoperative nausea and vomiting (PONV) were assessed.
Results
After excluding one patient, 59 patients were analyzed. There were no intergroup differences in baseline characteristics. The time to first analgesic requirement was longer in group D (305 [240, 510] minutes) than in group C (270 [180, 300] minutes) (
P
value = 0.02). The NRS at rest and on movement was lower in group D than in group C at 12 hours but did not differ at other time points. Postoperative morphine consumption was significantly lower in group D than in group C at 6,12,24 and 48 hours. Incidences of PONV were comparable between the groups.
Conclusion
Intravenous dexamethasone, used as an adjunct to a single-injection USG-TPVB prolonged analgesic duration, had an opioid-sparing effect and provided better postoperative pain relief after VATS.
Objectives: Anatomical lobectomy has always been the standard operative treatment of early-stage non-small cell lung cancer. However, there have been emerging evidences suggesting that a subanatomical resection, such as segmentectomy, may yield the same treatment results, even in patients with higher-stage non-small cell lung cancer. This study aimed to compare overall 5-year survival rate and disease-free survival between lobectomy and segmentectomy in patients with non-small cell lung cancer. Methods: The retrospective study included 380 patients who underwent surgery for non-small cell lung cancer at Ramathibodi Hospital between 1st January 2016 and 31st December 2020. Of 380 patients, 307 patients underwent lobectomy, while the other 73 patients underwent segmentectomy. Operative, admission, and follow-up data were collected from electronic medical records. Missing data were collected by telephone calls to patients or their relatives in deceased cases. Overall and disease-free survival were analyzed. Results: Median overall 5-year survival time after lobectomy and segmentectomy seemed to be different but not statistically significant (18.5 months versus 5.8 months, p = 0.127). Median disease-free survival time after lobectomy and segmentectomy was also similar (8.6 months versus 4.5 months, p = 0.511). Two deaths occurred during perioperative period, one from lobectomy group due to acute massive pulmonary embolism (0.3%) and the other from segmentectomy group due to acute exacerbation of chronic obstructive pulmonary disease with respiratory failure (1.4%). Conclusion: Lobectomy and segmentectomy result in similar overall 5-year survival rate and disease-free survival between these two comparison groups. Therefore, segmentectomy may be a potential alternative for operative treatment of non-small cell lung cancer. However, a larger and randomized-controlled trial may be needed to further validate these results.
The case discussed involves a 69-year-old Thai woman who underwent orthotopic heart transplantation 9 months before this event. She presented with fever without localizing signs or symptoms. However, her chest images revealed mass-like consolidation in the left upper lobe. Blood culture and lung tissue identified Rhodococcus equi.She was successfully treated with a combination of antimicrobial therapy, optimization of immunosuppressants, and surgical resection.
BackgroundThe aim of this study is to demonstrate that intraoperative PLC has a role in predicting clinical outcomes in NSCLC patients.MethodsIntraoperative PLC was performed in NSCLC patients who had no pleural effusion before the operation. PLC was performed three times for each patient. PLC1 was performed after the thoracotomy; PLC2 was performed immediately after complete operation; and PLC3 was performed after complete operation and washed the pleural cavity with 5,000 ml of normal saline solution. Clinical records of 178 patients in Ramathibodi Hospital from 2012 to 2016 were retrospectively reviewed and analysed for the relevance of intraoperative PLC and clinical outcomes.Results178 patients were included in this study; 67 patients were male (37.6%). Metastatic tumour from primary lung cancer occurred in 56 patients (31.4%). Positive intraoperative PLC was significantly associated with higher metastatic rate (p < 0.05). Survival rate in the positive intraoperative PLC group was significantly worse than that in the negative PLC group (p < 0.05).ConclusionsThis study shows positive intraoperative PLC was statistically significant for increasing metastatic rate and decreasing survival rate in NSCLC patients. Intraoperative PLC could provide important information for the prediction of disease progression and treatment planning.
source evidence and help patients to make informed treatment decisions. There is a risk that misinformation may lead patients in the wrong direction, which will then be a burden on the practitioner and negatively influence treatment outcomes. Datamining and crowdsourcing is a methodological system that gathers individual self-reported results from the Internet and converts it into credible RWE. For this patient, it increased the trustworthiness of the information and helped decrease anxiety about the treatment decision. Used appropriately, it has the potential to inform treatment decisions, help predict outcomes, and be a tool for post marketing surveillance that can be used to inform health technology assessment.
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