What this Trial Is About

Researchers are evaluating the effects of opioid-free combined anesthesia with preserved spontaneous breathing during video-assisted thoracoscopic surgery (VATS) for lung nodules. This study aims to assess how this "opioid-sparing strategy," which replaces opioids with ketamine during surgery, impacts recovery quality and speed, lung function, pain, gastrointestinal function, nausea, cognitive function, and mental health after surgery. The research is designed as a prospective, multicenter, randomized controlled trial with a 2x2 factorial design to provide high-level clinical evidence on these anesthesia approaches. The trial compares two ventilation methods—preserved spontaneous breathing using a laryngeal mask airway and mechanical ventilation via a double-lumen tracheal tube—along with two anesthesia approaches: opioid-based combined anesthesia and opioid-free combined anesthesia using esketamine. This creates four patient groups receiving different combinations of ventilation and anesthesia during their VATS lung nodule surgery. Experienced anesthetists and thoracic surgeons at six hospitals in China will conduct the study. Participants will be observed across three phases: the perioperative phase (day 0 to 2), the postoperative hospital stay (day 3 to 7), and a short-term follow-up period (day 8 to 30). Researchers will monitor lung function and adverse events related to anesthesia throughout these phases. The primary outcome is lung function measured 30 days after surgery. The study also tracks pain, pulmonary complications, gastrointestinal symptoms, nausea and vomiting, cognitive function, and emotional well-being to evaluate overall recovery and safety.

Opioid-Free Combined Anesthesia With Spontaneous Breathing for VATS