Comparison of Thoracoscopic Talc Pleurodesis by Thoracic Epidural or General Anesthesia

NCT ID: NCT01469728

Last Updated: 2011-11-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-11-30

Study Completion Date

2010-11-30

Brief Summary

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Video-assisted thoracoscopic surgery (VATS) talc pleurodesis is often carried out in patients with malignant recurrent pleural effusion to relieve symptoms and prevent recurrence.

General anesthesia and one lung ventilation is the standard type of anesthesia employed for VATS although recently, thoracic epidural anesthesia (TEA) in awake spontaneously ventilating patients is being increasingly employed to perform several cardio-thoracic surgery procedures in an attempt of minimize operative risks and facilitate resumption of daily-life activity.

The investigators have reasoned that for a simple and palliative procedure such as talc pleurodesis in cancer patients is, use of general anesthesia and one-lung ventilation might be considered a potential cause of morbidity and delayed recovery. The investigators have also hypothesized TEA could be considered an optimal type of anesthesia in this setting leading to a fast recovery a reduced overall workload in medical care.

In this single-center randomized study, the investigators have comparatively assessed the impact of awake TEA versus general anesthesia and one-lung ventilation on comprehensive results of VATS talc pleurodesis.

Detailed Description

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Conditions

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Pleural Effusion

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Awake VATS

Thoracoscopic talc pleurodesis performed in awake patients through sole thoracic epidural anesthesia.

Group Type EXPERIMENTAL

Awake VATS talc pleurodesis

Intervention Type PROCEDURE

Thoracoscopic talc pleurodesis performed in awake patients through sole thoracic epidural anesthesia.

Non-awake VATS talc pleurodesis

Thoracoscopic talc pleurodesis performed through sole general anesthesia and one-lung ventilation

Group Type ACTIVE_COMPARATOR

Non-awake VATS talc pleurodesis

Intervention Type PROCEDURE

Thoracoscopic talc pleurodesis performed through sole general anesthesia and one-lung ventilation

Interventions

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Non-awake VATS talc pleurodesis

Thoracoscopic talc pleurodesis performed through sole general anesthesia and one-lung ventilation

Intervention Type PROCEDURE

Awake VATS talc pleurodesis

Thoracoscopic talc pleurodesis performed in awake patients through sole thoracic epidural anesthesia.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Recurrent pleural effusion at the computed tomography occupying at least 1/3 of the hemithorax in patients with recent history of malignancy.
* Karnofsky performance status ≥ 50
* ASA score II-III
* Acceptance of the randomly assigned anesthesia protocol
* Radiologic evidence of lung re-expansion after previous drainage/thoracentesis
* Absence of blood clotting disorders (INR \< 1.5)
* No contraindications to TEA
* No neurological or psychiatric disturbance contraindicating awake surgery

Exclusion Criteria

* Patients refusal of random assignment to treatment arm
* Patients refusal or noncompliance to TEA
* Patients refusal or noncompliance to general anesthesia and one-lung ventilation
* Unfavourable anatomy for TEA
* Previous surgery of the thoracic spine
* Coagulation disorders (thromboplastin time \< 80%, prothrombin time \> 40 sec, platelet count \< 200/nL or bleeding disorders
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Rome Tor Vergata

OTHER

Sponsor Role lead

Responsible Party

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Eugenio Pompeo

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Policlinico Tor Vergata University

Rome, , Italy

Site Status

Countries

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Italy

References

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Pompeo E, Tacconi F, Mineo TC. Comparative results of non-resectional lung volume reduction performed by awake or non-awake anesthesia. Eur J Cardiothorac Surg. 2011 Apr;39(4):e51-8. doi: 10.1016/j.ejcts.2010.11.071.

Reference Type BACKGROUND
PMID: 21397783 (View on PubMed)

Pompeo E, Tacconi F, Frasca L, Mineo TC. Awake thoracoscopic bullaplasty. Eur J Cardiothorac Surg. 2011 Jun;39(6):1012-7. doi: 10.1016/j.ejcts.2010.09.029. Epub 2010 Oct 25.

Reference Type BACKGROUND
PMID: 20980159 (View on PubMed)

Vanni G, Tacconi F, Sellitri F, Ambrogi V, Mineo TC, Pompeo E. Impact of awake videothoracoscopic surgery on postoperative lymphocyte responses. Ann Thorac Surg. 2010 Sep;90(3):973-8. doi: 10.1016/j.athoracsur.2010.04.070.

Reference Type BACKGROUND
PMID: 20732526 (View on PubMed)

Pompeo E, Tacconi F, Mineo TC. Awake video-assisted thoracoscopic biopsy in complex anterior mediastinal masses. Thorac Surg Clin. 2010 May;20(2):225-33. doi: 10.1016/j.thorsurg.2010.01.003.

Reference Type BACKGROUND
PMID: 20451133 (View on PubMed)

Tacconi F, Pompeo E, Sellitri F, Mineo TC. Surgical stress hormones response is reduced after awake videothoracoscopy. Interact Cardiovasc Thorac Surg. 2010 May;10(5):666-71. doi: 10.1510/icvts.2009.224139. Epub 2010 Feb 23.

Reference Type BACKGROUND
PMID: 20179134 (View on PubMed)

Tacconi F, Pompeo E, Fabbi E, Mineo TC. Awake video-assisted pleural decortication for empyema thoracis. Eur J Cardiothorac Surg. 2010 Mar;37(3):594-601. doi: 10.1016/j.ejcts.2009.08.003. Epub 2009 Sep 16.

Reference Type BACKGROUND
PMID: 19762250 (View on PubMed)

Pompeo E, Mineo TC. Awake operative videothoracoscopic pulmonary resections. Thorac Surg Clin. 2008 Aug;18(3):311-20. doi: 10.1016/j.thorsurg.2008.04.006.

Reference Type BACKGROUND
PMID: 18831509 (View on PubMed)

Pompeo E, Mineo TC. Two-year improvement in multidimensional body mass index, airflow obstruction, dyspnea, and exercise capacity index after nonresectional lung volume reduction surgery in awake patients. Ann Thorac Surg. 2007 Dec;84(6):1862-9; discussion 1862-9. doi: 10.1016/j.athoracsur.2007.07.007.

Reference Type BACKGROUND
PMID: 18036900 (View on PubMed)

Pompeo E, Dauri M; Awake Thoracic Surgery Research Group. Is there any benefit in using awake anesthesia with thoracic epidural in thoracoscopic talc pleurodesis? J Thorac Cardiovasc Surg. 2013 Aug;146(2):495-7.e1. doi: 10.1016/j.jtcvs.2013.03.038. Epub 2013 Apr 17. No abstract available.

Reference Type DERIVED
PMID: 23601750 (View on PubMed)

Other Identifiers

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#20112

Identifier Type: OTHER

Identifier Source: secondary_id

107/07

Identifier Type: -

Identifier Source: org_study_id