Video-assisted Thoracoscopic Surgery

Shoulder pain is a common problem after certain types of lung surgery called video-assisted thoracoscopic surgery (VATS). This study examines whether a treatment called transcutaneous electrical acupoint stimulation (TEAS) can help reduce this pain. TEAS is a non-invasive technique that uses mild electrical stimulation at specific points on the body.Patients who are having VATS lung surgery will be randomly assigned to either receive TEAS before surgery or standard care. Researchers will measure how much shoulder pain patients experience and compare the two groups.The goal is to see if TEAS can help patients feel less pain and recover better after this type of lung surgery.

Thoracotomy is known as one of the most painful surgical procedures, with up to 65% of patients developing chronic post-thoracotomy pain syndrome (PTPS), and approximately 10% experiencing pain that significantly impacts quality of life. Video-assisted thoracoscopic surgery (VATS) has become increasingly common over the past decade and offers reduced postoperative pain, morbidity, and length of hospital stay compared to open thoracotomy. However, VATS can still cause moderate to severe postoperative pain and a high risk of chronic pain. Optimizing analgesia after VATS remains critical. With advances in ultrasound technology, several regional anesthesia techniques such as serratus anterior plane block (SAPB), erector spinae plane block (ESPB), and thoracic epidural analgesia (TEA) have shown comparable efficacy. In 2023, Tulgar et al. described the serratus posterior superior intercostal plane block (SPSIPB), which demonstrated dermatomal coverage from C3 to T10. This randomized controlled trial aims to compare the analgesic efficacy of SPSIPB and SAPB in patients undergoing VATS procedures.

To compare the rhomboid intercostal subserratus plane block with the erector spinae plane block regarding their analgesic efficacy and effects on respiratory function for patients undergoing video-assisted thoracoscopic surgery.

This study aims to compare lidocaine and dexmedetomidine infusion and their combination on perioperative pain in patients undergoing video-assisted thoracoscopic surgery.

In this study, we want to find out if measuring carbon dioxide from a patient's breath (end-tidal CO₂ or ETCO₂) can reliably reflect changes in blood carbon dioxide levels (arterial CO₂ or PaCO₂) during lung surgery. Instead of just looking at individual values, we are specifically investigating whether ETCO₂ and PaCO₂ rise and fall in the same direction over time. During lung surgery, patients often need "one-lung ventilation," where only one lung is used for breathing while the other is deflated to help the surgeon. This can cause carbon dioxide levels in the blood to change, which are typically monitored by taking blood samples. If ETCO₂ trends closely follow PaCO₂ trends, doctors may not need to take as many blood samples. Patients in this study will already have a small tube in an artery for monitoring blood pressure. Whenever a blood test is taken, we will compare the blood CO₂ level with the ETCO₂ reading at that moment. We will also track heart rate, blood pressure, and body temperature. By comparing these measurements, we hope to learn whether ETCO₂ reliably follows the same trends as PaCO₂, making it a useful tool for monitoring carbon dioxide levels in lung surgery with fewer blood tests.

Since the removal of the chest tube is a painful procedure, it can cause serious anxiety in patients. Patients state that chest tube removal is among the bad memories they experience. The source of the anxiety may be related to fear and anxiety about the pain caused by the upcoming chest tube removal procedure, or it may be the words they have heard from other patients who have had this experience before. There are a limited number of studies in the literature on anxiety that may occur in patients due to chest tube withdrawal. In addition, studies in the literature did not focus on whether there was a difference between pre-procedure and post-procedure anxiety levels. In this study, it was aimed to investigate the anxiety levels before and after the procedure and the pain levels felt in the patients due to the procedure due to chest tube withdrawal in patients who underwent VATS. In addition, it aimed to investigate whether there is any correlation between pre-procedure anxiety and pain experienced during the procedure. If a correlation is detected, the importance of pre-procedural anxiety management will be better understood, the necessity of interventions such as psychological and pharmacological treatment for anxiety will come to the fore, and new research on this subject will be needed.

The goal of this clinical trial is to compare the analgesic efficacy of thoracal paravertebral block (TPVB) and serratus posterior superior intercostal plane block (SPSIPB) in patients undergoing video-assisted thoracoscopic surgery (VATS). The main questions it aims to answer are: How will the total perioperative opioid consumption of the patients receiving two different blocks change? How will TPVB and SPSIPB effect the patients' numeric rating scores for pain in the postoperative 24-hour period? How will TPVB and SPSIPB effect the incidence of opioid related side effects? Participants will be divided in two groups: TPVB group will receive a TPVB before the surgery. SPSIPB group will receive a SPSIPB nerve block before the surgery. Researchers will compare the results between the groups to see the postoperative effects concerning opioid consumption as well as the pain scores, respiratory parameters and opioid associated side effects. The hypothesis of this study is that participants receiving SPSIPB for VATS will have a less total opioid consumption 24 hours postoperatively.