Post operative pain in mini invasive thoracic surgery: video assisted vs robotic assisted thoracoscopy : an ancillary study on the artist data base

Position du problème et objectif(s) de l’étude

Minimally invasive thoracic surgery, including Video-Assisted Thoracoscopic Surgery (VATS) and Robotic-Assisted Thoracoscopic Surgery (RATS), aims to reduce postoperative pain compared to conventional thoracotomy. While RATS offers ergonomic advantages such as improved precision and enhanced instrument control, its true impact on postoperative pain and opioid consumption remains unclear. The primary objective of this study was to compare postoperative morphine consumption between VATS and RATS from the Post-Anesthesia Care Unit (PACU) to postoperative day 3.

Matériel et méthodes

This study used data from the ARTIST study database (NCT05126524), collected across 23 French centers between April 2021 and October 2022. Ethical approval was obtained from the Ethics Committee for Research in Anesthesia and Critical Care (IRB 00010254 – 2023 – 045). Patients with missing data were excluded. Mean opioid consumption was calculated in milligrams of intravenous morphine equivalents (MME). Secondary outcomes included the type of regional anesthesia (RA), postoperative complications (broncho-pleural fistula, pleural effusion, pneumothorax, atelectasis, pneumopathy, acute respiratory distress syndrome, atrial fibrillation, myocardial ischemia, acute pulmonary edema, and cardiac arrest), intensive care unit admission, duration of chest drainage, and length of hospital stay. Multivariable analysis was conducted to adjust for potential confounders, including number of incisions, RA use, and study center.

Résultats & Discussion

A total of 371 patients were included in the analysis (275 VATS, 96 RATS). The RATS group showed significantly higher mean opioid consumption from PACU to postoperative day 3 compared to the VATS group (26.3 mg vs. 20 mg; p = 0.018). Opioid consumption across various postoperative endpoints is shown in Figure 1. However, after adjusting for surgical variables, this difference was no longer statistically significant (p = 0.168). RA was more frequently performed in the VATS group (95.6% vs. 86.6%; p = 0.002), with paravertebral block (PVB) being the most commonly used technique in both groups (68.1% vs. 70.8%; p = 0.304). There were no significant differences between groups regarding the incidence of individual postoperative complications. However, the overall complication rate was significantly higher in the VATS group (19.3% vs. 8.3%; p = 0.011). No significant differences were found between groups in terms of ICU admission, chest drainage duration, or length of hospital stay.

Conclusion

RATS was not independently associated with increased postoperative opioid consumption when surgical variables were accounted for. These findings underscore the importance of further randomized studies incorporating standardized pain assessments and multimodal analgesia strategies. As newer, less invasive techniques such as uniportal RATS continue to emerge, they may offer additional benefits in reducing postoperative pain and opioid requirements.

Auteurs

Grégoire LE GAC (1) , Cédric VAN ASSCHE (1), Bertrand RICHARD DE LATOUR (2), Alexandre MANSOUR (1), Nicolas NESSELER (1) - (1)Department Of Anesthesia And Critical Care, Pontchaillou, University Hospital Of Rennes, France, Rennes, France, (2)Department Of Thoracic And Cardiovascular Surgery, Pontchaillou, University Hospital Of Rennes, France, Rennes, France

Orateur(s)

Grégoire LE GAC (Rennes)