This prospective, randomized study is designed to evaluate the effectiveness of postoperative care pathway using the Fast Track Rehabilitation protocol (FTR) in comparison with the traditional postoperative care. In order to conduct this study, patients having a thoracic surgery will be randomly attributed to FTR protocol group or control group.
Traditionally, patients who underwent thoracic surgery have been treated with a classical protocol which include; bed rest, ambulation prohibited for 24-48 hours and starvation for several postoperative days till the recovery of bowel. Some studies reported the efficacy of early rehabilitation protocols or FTR protocols in thoracic surgery to reduce postoperative complications and to minimize hospital stay. But these studies are few and retrospective. Prospective randomized trials focuses based on the "fast track regimen" or medical fast track that interest only on the medical component . This prospective, randomized study is designed to evaluate the effectiveness of postoperative care pathway using FTR protocol in comparison with the traditional postoperative care. In order to conduct this study, patients having a thoracic surgery will be randomly attributed to FTR protocol group or control group.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
100
In postoperative phase: Early exercises: within the first hour ;setting a half bed position, deep breathing and coughing . In the second hour, curbing vagal malaise and performing relaxation movements. In the third hour, walking about 20 to 30 minutes.
In postoperative phase : Removing urinary probe and all catheters.
In postoperative phase :Early alimentation: in the first hour to the second hour .
Cardiovascular and thoracic surgery department - Habib Bouguiba University Hospital
Sfax, Tunisia
RECRUITINGPostoperative Complications: Atelectasis or re-expansion failure or pneumonic infection
discharge criteria: * Chest tube removal * Unassisted ambulation * Afebrile without major complications * Willing discharge
Time frame: within postoperative 30 days
Pain
score measured by the Visual Analog Scale.
Time frame: in 1st hour , 2nd hour , 3rd hour , 6th hour 24th hour , 48th hour at the postoperative , within postoperative 30 days
The Length of Hospital Stay
Time frame: within postoperative 30 days
Thoracic surgery postoperative Complications
During the First Admission : Prolonged bubbling
Time frame: within postoperative 30 days
Surgery postoperative Complications : pulmonary embolism or cardiac arrhythmia or pleural empyema
Time frame: within postoperative 30 days
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* In preoperative phase: stopping smoking at least 2 weeks, hospitalization and balanced alimentation one day before the surgery. * In peroperative phase : no use of benzodiazepines in the anesthesia , selective intubation , maintaining vital parameters as normal and using a mini invasive surgical approach ( video thoracoscopy , video assisted thoracoscopy , thoracotomy with preservation of the posterior muscles of the chest wall , preservation of Serratus anterior and the front part of Latissimus Dorsi ). * In postoperative phase : Immediate extubation ( less than 30 minutes from the surgery end) , peridural or paravertebral or intercostal block analgesia , no use of abusive antibiotic , all analgesic drugs are permitted if there are no contraindications and physiotherapy from the 6th hour.