This study intends to explore a new therapy to reduce the incidence of atrial fibrillation in thoracic patient who receive video-assisted thoracoscopic lobectomy .The results of the study are to assess the effects of this new intervention on the incidence，duration of atrial fibrillation and other complications including postoperative delirium after video-assisted thoracoscopic lobectomy .And reducing the burden of POAF on patients and their families, hospitals and public resources.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
150
Injecting 1% lidocaine 1.5ml+0.375% ropivacaine 1.5ml into vascular sheaths of all pulmonary vein of the surgery side at the beginning of surgery operation. Wrapping all pulmonary vein of the surgery side with cotton sheet infiltrated with 1% lidocaine+0.375% ropivacaine at the end of surgery operation. Blocking vagus nerve above the aortic vein on the right side of the trachea with 1% lidocaine 1ml+0.375% ropivacaine 1ml after exposing the pleural apex.
Department of Anesthesiology of the Affiliated Hospital of Xuzhou Medical University
Xuzhou, Jiangsu, China
RECRUITINGincidence of POAF
Continuous ECG recordings were made on Holter recorders for 72 hours after the operation. Arrhythmia detection were done automatically by template matching. The decisions made automatically by the computer were reviewed and corrected by an experienced technician and then by a cardiologist.
Time frame: 72 hours after surgery
the Trail Making Test
the neuropsychological test to measure cognitive function
Time frame: 1 day before surgery(baseline)
the Grooved Pegboard Test
the neuropsychological test to measure cognitive function
Time frame: 1 day before surgery(baseline)
the Digit Span Test
the neuropsychological test to measure cognitive function
Time frame: 1 day before surgery(baseline)
the Number-Symbol Replacement Test
the neuropsychological test to measure cognitive function
Time frame: 1 day before surgery(baseline)
the Finger Tapping Test
the neuropsychological test to measure cognitive function.
Time frame: 1 day before surgery(baseline)
the Word Fluency Test
the neuropsychological test to measure cognitive function
Time frame: 1 day before surgery(baseline)
the Building Block Test
the neuropsychological test to measure cognitive function
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Time frame: 1 day before surgery(baseline)
Mini-Mental score examination (MMSE)
Mini-Mental score examination \[MMSE\] used for screening of dementia
Time frame: 1 day before surgery(baseline)，6±1 days after surgery，one month after surgery
Quality of Recovery Score - 40 (QoR-40)
Quality of recovery will be evaluated by Quality of Recovery 40 (QoR40),which assesses five dimensions of recovery (physical comfort,emotional state, physical independence , physiological support and pain ). Each item is rated on a five-point Likert scale: none of the time, some of the time, usually, most of the time, and all the time. The total score on the QoR40 ranges from 40 (poorest quality of recovery) to 200 (best quality of recovery).
Time frame: 1 day before surgery(baseline)，1 day after surgery
specific time of POAF
Specific time of POAF，such as 9：00AM，first day after surgery
Time frame: 72 hours after surgery
incidence of other arrhythmia
Continuous ECG recordings were made on Holter recorders for 72 hours after the operation. Arrhythmia detection were done automatically by template matching. The decisions made automatically by the computer were reviewed and corrected by an experienced technician and then by a cardiologist.
Time frame: 72 hours after surgery
Ventricular rate during POAF
Continuous ECG recordings were made on Holter recorders for 72 hours after the operation.
Time frame: 72 hours after surgery
Incidence of postoperative delirium
Confusion Assessment Method（CAM) to measure delirium
Time frame: before discharge from PACU，twice a day every 12 hours within 3 days after surgery
Numerical Rating Scale（NRS）
Evaluate the severity using numerical rating scale（NRS）, where zero mean no pain and 10 the worst imaginable pain.
Time frame: before discharge from PACU，twice a day every 12 hours within 3 days after surgery
incidence of POAF
Conduct electrocardiogram in patients with heartache or other symptoms.The decisions made by an experienced technician and then confirmed by a cardiologist.
Time frame: 4-14 days after surgery
incidence of other arrhythmia
Conduct electrocardiogram in patients with heartache or other symptoms.The decisions made by an experienced technician and then confirmed by a cardiologist.
Time frame: 4-14 days after surgery
incidence of POAF
Conduct electrocardiogram in patients with heartache or other symptoms.The decisions made by an experienced technician and then confirmed by a cardiologist.
Time frame: 15-30 days after surgery
incidence of other arrhythmia
Conduct electrocardiogram in patients with heartache or other symptoms.The decisions made by an experienced technician and then confirmed by a cardiologist.
Time frame: 15-30 days after surgery
incidence of postoperative complications
incidence of respiratory complications, intestinal obstruction, acute renal failure, wound infection, cerebrovascular accident
Time frame: 1-30 days after surgery
re-admission within 30 days after surgery
incidence and cause of re-admission
Time frame: 1-30 days after surgery
mortality
incidence and cause of mortality
Time frame: within 30 days after surgery
hospitalization expenses
hospitalization expenses
Time frame: up to 30 days after surgery
Postoperative length of stay
Postoperative length of stay
Time frame: up to 30 days after surgery
admission into ICU
incidence and length of admission into ICU
Time frame: up to 30 days after surgery
Analgesic dose
postoperative analgesic dose converted to morphine equivalents
Time frame: up to 7 days after surgery
incidence of second operation
incidence of unplanned second operation due to direct or indirect complications of the original surgery
Time frame: 1 month after surgery
the Trail Making Test
the neuropsychological test to measure cognitive function
Time frame: 3-6months after surgery
the Grooved Pegboard Test
the neuropsychological test to measure cognitive function
Time frame: 3-6months after surgery
the Digit Span Test
the neuropsychological test to measure cognitive function
Time frame: 3-6months after surgery
the Number-Symbol Replacement Test
the neuropsychological test to measure cognitive function
Time frame: 3-6months after surgery
the Finger Tapping Test
the neuropsychological test to measure cognitive function
Time frame: 3-6months after surgery
the Word Fluency Test
the neuropsychological test to measure cognitive function
Time frame: 3-6months after surgery
the Building Block Test
the neuropsychological test to measure cognitive function
Time frame: 3-6months after surgery