LAUSR

Introduction Robot-assisted thoracic surgery (RATS) has emerged as a minimal-invasive surgical approach, but little is known about anaesthetic and analgesic management and postoperative complications (1). Methods Retrospective, single-centre, observational study including 50 patients operated by RATS between January-October 2019. Exclusion criteria were loss of data and surgical technique reconversion. Demographic data, length of stay in intensive care unit (ICU) and in hospital, acute postoperative pain assessed by numerical rating scale (NRS: 0-10), postoperative nausea and vomiting (PONV), and major complications was collected. Statistical analysis was performed with STATA/IC15.1® and Kruskal-wallis test was used. Categorical data are presented as n (%) and continuous data as mean [standard deviation (SD)]. Results Mean age was 61.6 years (SD 13.6) with 27 (54%) men and 23 (46%) women. 35 (70%) patients corresponded to ASA classification I-II whereas 15 (30%) corresponded to III-IV. Thymectomy was performed in 18 (36%) patients, and lung resection in 32 (64%), including 21 (42%) lobectomies and 11 (22%) wedge resections. 43 (86%) patients underwent general anaesthesia with sevoflurane and 7 (14%) with propofol infusion. Lung isolation was performed with a double-lumen tube in all patients. In 26 (52%) subjects invasive arterial blood pressure was monitored. Central lines were not inserted in any patient while urinary catheter in 29 (58%). Regional analgesia techniques were intercostal infiltration in 30 (60%) patients, ultrasound-guided serratus anterior plane (SAP) block in 16 (32%) and both techniques in 4 (8%). SAP and combined techniques groups received less fentanyl intraoperatively than intercostal infiltration group (p=0.028) (table 1). No epidural nor paravertebral catheters were placed. Multimodal analgesia was performed in all patients (table 2). All patients were extubated in operating theatre; 32 (64%) were admitted to ICU with an average stay of 19.8 (SD 3.7) hours with no readmissions, and 18 (36%) subjects were transferred to the ward. Mean hospitalization length was 3.2 (SD 2.2) days. 2 thymectomized patients were discharged home same day of procedure Mean postoperative pain at 1, 24 and 48 hours was 2.6 (SD 2.5), 1.5 (SD 1.8) and 0.9 (SD 1.3). In ICU, pain was treated with intravenous morphine boluses in 28 (56%) patients and morphine patient-controlled analgesia in 8 (16%), in addition to paracetamol and NSAIDs. 14 (28%) patients developed PONV in first 24 hours. Four cases of pneumothorax in operated lung were reported as major complications. Discussion This study seems to reflect a trend towards less invasive surgical technique and also anaesthetic approach. RATS seems to be feasible in our population with encouraging results in terms of ICU and hospital length of stay and low acute postoperative pain. Performing SAP block as analgesic technique could reduce intraoperative consumption of opioids, but further larger prospective trials may be considered.