Patients’ satisfaction with local and general anaesthesia for video-assisted thoracoscopic surgery—results of the first randomized controlled trial PASSAT

Abstract

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.