Lung NeoplasmsPhase 4SEAVATSNCT02359175
Supplementary Epidural Analgesia in Video-Assisted Thoracic Surgery (VATS) - The SEAVATS Study
A Phase 4 study testing Bupivacaine in epidural catheter, Fentanyl in epidural catheter and Oral Paracetamol in people with Lung Neoplasms and Pain, run by Odense University Hospital at 1 site in Denmark.
Trial summary
Whereas it, in the case of conventional thoracotomy, has been demonstrated that thoracic epidural analgesia is more effective than systemic opioids in terms of pain relief and preservation of postoperative pulmonary function, the efficacy of epidural analgesia in video-assisted thoracic surgical (VATS) procedures, has… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Lung Neoplasms, Pain, Immune Suppression
- What is being tested?
- Bupivacaine in epidural catheter, Fentanyl in epidural catheter and Oral Paracetamol
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 161 participants
- Where
- 1 siteDenmark
- Study dates
- Feb 2015to 22 Mar 2023
- Phase
- Phase 4
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Planned elective VATS lobectomy, wedge- or segmental resection. (for the subsequent biomarker study, only lobectomy is a inclusion criteria, specified in protocol amendment July 27th 2016)
- Patient has accepted to have epidural analgesia as part of the anaesthesia for the procedure.
- Informed consent is attained.
- Patient is over 18 years of age.
- Patient is mentally able to answer questionnaires included in the study.
Who cannot join
- Allergies to any of the medications used in the trial.
- History of previous peptic ulcer.
- History of chronic pain to any degree that will interfere with quantification of pain postoperatively.
- Dementia or reduced mental capacity to any degree that will interfere with quantification of pain postoperatively.
- Pregnancy.
- Contra-indications to placement of epidural catheter.
- Any concurrent cancer disease or use of immune modulating drugs (criteria added as part of a protocol amendment July 27th 2016 for a subsequent biomarkers study)
Trial locations and contacts
1 site in 1 country.
About this study
Whereas it, in the case of conventional thoracotomy, has been demonstrated that thoracic epidural analgesia is more effective than systemic opioids in terms of pain relief and preservation of postoperative pulmonary function, the efficacy of epidural analgesia in video-assisted thoracic surgical (VATS) procedures, has not been sufficiently studied, but a beneficial effect might very well be present.
On the other hand, the risks associated with placement of a thoracic epidural catheter are well known and if similar pain relief can be achieved without it with no or only insignificant alternative side effects, this would be preferable.
Read more
The literature regarding the usefulness of epidural analgesia for reducing pain in Video-Assisted Thoracic Surgery is, at best, scarce with two small studies showing some effect and two showing no difference, none of the studies being blinded randomized controlled trials of adequate size.
The SEAVATS Study will try to answer this question.
Read the detailed description
Study plan:
The hypothesis is that there is no difference in the amount of pain the patients will experience after VATS for pulmonary neoplasms.
Study design and setting:
The project is designed as a prospectively, double blinded, randomized, placebo controlled study comparing pain in two groups of patients.
Both groups of patients will:
- Have a epidural catheter placed.
- Receive a basis level of analgesics consisting of paracetamol and a nonsteroidal anti- inflammatory drug combined with a nerveblock placed intercostally during surgery.
- Have access to i.v. opioids as needed for any experienced pain after surgery.
One group of patients will be given local anaesthetics through the epidural catheter supplemented with placebo medication orally while the other group will receive saline in the epidural catheter supplemented with opioids orally.
Data collection:
Data will, during hospitalization, be collected in the operating theatre, in the postoperative care unit and in the surgical ward. Six months after surgery a questionnaire will be send to the patients to do follow-up regarding residual sequelae after surgery and placement of epidural catheter. Further follow-up with questionnaire has been planned for subsequent years.
As a secondary objective, in fifty-six of the patients from The SEAVATS Study, blood samples will be gathered during surgery and one hour and 24 hours after surgery, and compared with pre-operative levels.
These blood samples will be analysed for immune cells (NK-cells, levels and activity) and cytokines (IL-6, IL-10, IL-12 and IFN-gamma) as indicators of immunological response to surgery.
Research ethics:
The project has obtained ethics approval from The Regional Scientific Ethical Committees for Southern Denmark and acceptance to perform clinical research has been granted by The Danish Health and Medicines Authority. Consent to data collection has been provided by The Danish Data Protection Agency. Before entering the project, consent will be obtained from all patients. Rigorous data security will be maintained for five years and afterwards all data will be deleted. The Study is registered with The European Union Drug Regulating Authorities Clinical Trials Database (EudraCT) with EudraCT number 2014-000760-18 and is monitored by The Good Clinical Practice unit for Southern Denmark.
- Conditions
- Lung Neoplasms, Pain, Immune Suppression
- Being tested
- Bupivacaine in epidural catheter, Fentanyl in epidural catheter, Placebo (for Bupivacain and Fentanyl i epidural catheter), Oral Paracetamol, Oral NSAID
- Keywords
- Pain, Pain Measurement, VAS, Visual Analog Pain Scale, Analgesics, Opioid, Epidural analgesia, VATS, Video-assisted Thoracic Surgery, Lobectomy, Wedge Resection, Segmental Resection, Cytokins, Immune cells
- Medical subject headings
- Lung Neoplasms, Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Bupivacaine in epidural catheterDrug
Bupivacain to be given in epidural catheter
Fentanyl in epidural catheterDrug
Fentanyl to be given in epidural catheter
Placebo (for Bupivacain and Fentanyl i epidural catheter)Drug
Saline to be given in epidural catheter
Oral ParacetamolDrug
Paracetamol to be given orally
Oral NSAIDDrug
NSAID to be given orally
Oral opioidsDrug
Opioids to be given orally
Placebo (for oral opioids)Drug
Placebo tablets to be given instead of oral opioids
| Study group | Role | What they receive |
|---|---|---|
| Active Epidural analgesia | Active comparator | Epidural catheter: Bupivacain 1,0 mg/ml + Fentanyl 2 micrograms/ml. Oral analgesia: Paracetamol, NSAID and placebo tablets. Receives: Drug: Bupivacaine in epidural catheter; Drug: Fentanyl in epidural catheter; Drug: Oral Paracetamol; Drug: Oral NSAID; Drug: Placebo (for oral opioids) |
| Placebo Epidural analgesia | Active comparator | Epidural analgesia: Placebo. Oral analgesia: Paracetamol, NSAID and opioids tablets. Receives: Drug: Placebo (for Bupivacain and Fentanyl i epidural catheter); Drug: Oral Paracetamol; Drug: Oral NSAID; Drug: Oral opioids |
What is being measured
The primary outcome is the main question the study is designed to answer.
Intensity of pain (Self reported pain intensity)
Self reported pain intensity 5 times a day both in rest and during activity until chest tube is removed or day 4 after operation is reached.
Measured: 0-4 days
Consumption "Rescue Analgesia" - i.v. opioids
The consumption of i.v. opioids is registered daily until chest tube is removed or day 4 after operation is reached.
Measured: 0-4 days
Secondary outcomes (5)
Duration of surgery
The duration of the surgical procedure will be registered.
Measured: 0-4 days
Length of hospital stay
Admission time after surgery.
Measured: 0-4 days
Time used placing epidural catheter
Procedural time and competence level of MD placing catheter
Measured: 0-4 days
Side effects of epidural analgesia
Side effects observed using epidural analgesia including itching, nausea, vomiting, procedural pain, hypotension, dizziness, respiratory depression, reduced pulmonary function.
Measured: 0-4 days
Sequelae following VATS and placement of epidural catheter
Questionnaire sent to patients 6, 12, 24 and 60 months after surgery. (criteria edited as part of a protocol amendment July 27th 2016 for a subsequent biomarkers study).
Measured: 60 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted9 Feb 2015 (estimated)
- Study startFeb 2015
- Primary completion24 Jan 2019
- Study completion22 Mar 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (8)Papers the sponsor has linked to this study.
- Other trials for Lung NeoplasmsStudies of the same condition, open and under way.
- More trials run by Odense University HospitalThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 4
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 161 participants (actual)
Sponsor and investigators
- Lead sponsor
- Odense University Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Jimmy Højberg Holm, Odense University Hospital
- Investigators
- Jimmy H Holm, MD, Principal investigator, Department of Anaesthesia and Intensive Care - Odense University Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02359175
- Sponsor's protocol ID
- 13.034
- Acronym
- SEAVATS
- Status last verified
- Jun 2023
- First submitted
- 4 Feb 2015
- Last updated
- 27 Jun 2023
- Results posted
- No
- Data monitoring committee
- Yes
- Individual data sharing
- No
Publications
Richardson J, Cheema S. Thoracic paravertebral nerve block. Br J Anaesth. 2006 Apr;96(4):537. doi: 10.1093/bja/ael038. No abstract available.
PubMed 16549628Kim JA, Kim TH, Yang M, Gwak MS, Kim GS, Kim MJ, Cho HS, Sim WS. Is intravenous patient controlled analgesia enough for pain control in patients who underwent thoracoscopy? J Korean Med Sci. 2009 Oct;24(5):930-5. doi: 10.3346/jkms.2009.24.5.930. Epub 2009 Sep 23.
PubMed 19794994Freise H, Van Aken HK. Risks and benefits of thoracic epidural anaesthesia. Br J Anaesth. 2011 Dec;107(6):859-68. doi: 10.1093/bja/aer339. Epub 2011 Nov 4.
PubMed 22058144Yie JC, Yang JT, Wu CY, Sun WZ, Cheng YJ. Patient-controlled analgesia (PCA) following video-assisted thoracoscopic lobectomy: comparison of epidural PCA and intravenous PCA. Acta Anaesthesiol Taiwan. 2012 Sep;50(3):92-5. doi: 10.1016/j.aat.2012.08.004. Epub 2012 Sep 7.
PubMed 23026166Yoshioka M, Mori T, Kobayashi H, Iwatani K, Yoshimoto K, Terasaki H, Nomori H. The efficacy of epidural analgesia after video-assisted thoracoscopic surgery: a randomized control study. Ann Thorac Cardiovasc Surg. 2006 Oct;12(5):313-8.
PubMed 17095972Fernandez MI, Martin-Ucar AE, Lee HD, West KJ, Wyatt R, Waller DA. Does a thoracic epidural confer any additional benefit following video-assisted thoracoscopic pleurectomy for primary spontaneous pneumothorax? Eur J Cardiothorac Surg. 2005 Apr;27(4):671-4. doi: 10.1016/j.ejcts.2004.12.045.
PubMed 15784372Holm JH, Andersen C, Licht PB, Toft P, Zegers FD, Lambertsen KL, Brochner AC. Immunological effects of post-operative epidural analgesia versus oral opioids in VATS. Dan Med J. 2024 Sep 9;71(10):A09230582. doi: 10.61409/A09230582.
PubMed 39323258Holm JH, Andersen C, Toft P. Epidural analgesia versus oral morphine for postoperative pain management following video-assisted thoracic surgery: A randomised, controlled, double-blind trial. Eur J Anaesthesiol. 2024 Jan 1;41(1):61-69. doi: 10.1097/EJA.0000000000001921. Epub 2023 Nov 15.
PubMed 37962202
Study at a glance
From the registry record, last updated by the sponsor on 27 Jun 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Supplementary Epidural Analgesia in Video-Assisted Thoracic Surgery (VATS) - The SEAVATS Study
- ClinicalTrials.gov ID
- NCT02359175
- Acronym / sponsor ID
- SEAVATS / 13.034
- Conditions
- Lung Neoplasms, Pain, Immune Suppression
- Keywords
- Pain, Pain Measurement, VAS, Visual Analog Pain Scale, Analgesics, Opioid, Epidural analgesia, VATS
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 161 participants (actual)
- Lead sponsor
- Odense University HospitalUniversity, hospital or other
- Study start
- Feb 2015 (actual)
- Primary completion
- 24 Jan 2019 (actual)
- Study completion
- 22 Mar 2023 (actual)
- First posted
- 9 Feb 2015 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Whereas it, in the case of conventional thoracotomy, has been demonstrated that thoracic epidural analgesia is more effective than systemic opioids in terms of pain relief and preservation of postoperative pulmonary function, the efficacy of epidural analgesia in video-assisted thoracic surgical (VATS) procedures, has not been sufficiently studied, but a beneficial effect might very well be present.
On the other hand, the risks associated with placement of a thoracic epidural catheter are well known and if similar pain relief can be achieved without it with no or only insignificant alternative side effects, this would be preferable.
The literature regarding the usefulness of epidural analgesia for reducing pain in Video-Assisted Thoracic Surgery is, at best, scarce with two small studies showing some effect and two showing no difference, none of the studies being blinded randomized controlled trials of adequate size.
The SEAVATS Study will try to answer this question.
Detailed description
Study plan:
The hypothesis is that there is no difference in the amount of pain the patients will experience after VATS for pulmonary neoplasms.
Study design and setting:
The project is designed as a prospectively, double blinded, randomized, placebo controlled study comparing pain in two groups of patients.
Both groups of patients will:
- Have a epidural catheter placed.
- Receive a basis level of analgesics consisting of paracetamol and a nonsteroidal anti- inflammatory drug combined with a nerveblock placed intercostally during surgery.
- Have access to i.v. opioids as needed for any experienced pain after surgery.
One group of patients will be given local anaesthetics through the epidural catheter supplemented with placebo medication orally while the other group will receive saline in the epidural catheter supplemented with opioids orally.
Data collection:
Data will, during hospitalization, be collected in the operating theatre, in the postoperative care unit and in the surgical ward. Six months after surgery a questionnaire will be send to the patients to do follow-up regarding residual sequelae after surgery and placement of epidural catheter. Further follow-up with questionnaire has been planned for subsequent years.
As a secondary objective, in fifty-six of the patients from The SEAVATS Study, blood samples will be gathered during surgery and one hour and 24 hours after surgery, and compared with pre-operative levels.
These blood samples will be analysed for immune cells (NK-cells, levels and activity) and cytokines (IL-6, IL-10, IL-12 and IFN-gamma) as indicators of immunological response to surgery.
Research ethics:
The project has obtained ethics approval from The Regional Scientific Ethical Committees for Southern Denmark and acceptance to perform clinical research has been granted by The Danish Health and Medicines Authority. Consent to data collection has been provided by The Danish Data Protection Agency. Before entering the project, consent will be obtained from all patients. Rigorous data security will be maintained for five years and afterwards all data will be deleted. The Study is registered with The European Union Drug Regulating Authorities Clinical Trials Database (EudraCT) with EudraCT number 2014-000760-18 and is monitored by The Good Clinical Practice unit for Southern Denmark.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Active Epidural analgesia | Active comparator | Drug: Bupivacaine in epidural catheter, Drug: Fentanyl in epidural catheter, Drug: Oral Paracetamol, Drug: Oral NSAID, Drug: Placebo (for oral opioids)Epidural catheter: Bupivacain 1,0 mg/ml + Fentanyl 2 micrograms/ml. Oral analgesia: Paracetamol, NSAID and placebo tablets. |
| Placebo Epidural analgesia | Active comparator | Drug: Placebo (for Bupivacain and Fentanyl i epidural catheter), Drug: Oral Paracetamol, Drug: Oral NSAID, Drug: Oral opioidsEpidural analgesia: Placebo. Oral analgesia: Paracetamol, NSAID and opioids tablets. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Planned elective VATS lobectomy, wedge- or segmental resection. (for the subsequent biomarker study, only lobectomy is a inclusion criteria, specified in protocol amendment July 27th 2016)
- Patient has accepted to have epidural analgesia as part of the anaesthesia for the procedure.
- Informed consent is attained.
- Patient is over 18 years of age.
- Patient is mentally able to answer questionnaires included in the study.
Key exclusion criteria (7 listed)
- Allergies to any of the medications used in the trial.
- History of previous peptic ulcer.
- History of chronic pain to any degree that will interfere with quantification of pain postoperatively.
- Dementia or reduced mental capacity to any degree that will interfere with quantification of pain postoperatively.
- Pregnancy.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Bupivacaine in epidural catheterBupivacain to be given in epidural catheter | Drug | Active Epidural analgesia |
| Fentanyl in epidural catheterFentanyl to be given in epidural catheter | Drug | Active Epidural analgesia |
| Placebo (for Bupivacain and Fentanyl i epidural catheter)Saline to be given in epidural catheter | Drug | Placebo Epidural analgesia |
| Oral ParacetamolParacetamol to be given orally | Drug | Active Epidural analgesia, Placebo Epidural analgesia |
| Oral NSAIDNSAID to be given orally | Drug | Active Epidural analgesia, Placebo Epidural analgesia |
| Oral opioidsOpioids to be given orally | Drug | Placebo Epidural analgesia |
| Placebo (for oral opioids)Placebo tablets to be given instead of oral opioids | Drug | Active Epidural analgesia |
Primary outcome
Intensity of pain (Self reported pain intensity)
Time frame: 0-4 days
Self reported pain intensity 5 times a day both in rest and during activity until chest tube is removed or day 4 after operation is reached.
Consumption "Rescue Analgesia" - i.v. opioids
Time frame: 0-4 days
The consumption of i.v. opioids is registered daily until chest tube is removed or day 4 after operation is reached.
5 secondary outcomes
Duration of surgery
Time frame: 0-4 days
Length of hospital stay
Time frame: 0-4 days
Time used placing epidural catheter
Time frame: 0-4 days
Side effects of epidural analgesia
Time frame: 0-4 days
Sequelae following VATS and placement of epidural catheter
Time frame: 60 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 27 Jun 2023.
- Background: PubMed 16549628Richardson J, Cheema S. Thoracic paravertebral nerve block. Br J Anaesth. 2006 Apr;96(4):537. doi: 10.1093/bja/ael038. No abstract available.
- Background: PubMed 19794994Kim JA, Kim TH, Yang M, Gwak MS, Kim GS, Kim MJ, Cho HS, Sim WS. Is intravenous patient controlled analgesia enough for pain control in patients who underwent thoracoscopy? J Korean Med Sci. 2009 Oct;24(5):930-5. doi: 10.3346/jkms.2009.24.5.930. Epub 2009 Sep 23.
- Background: PubMed 22058144Freise H, Van Aken HK. Risks and benefits of thoracic epidural anaesthesia. Br J Anaesth. 2011 Dec;107(6):859-68. doi: 10.1093/bja/aer339. Epub 2011 Nov 4.
- Background: PubMed 23026166Yie JC, Yang JT, Wu CY, Sun WZ, Cheng YJ. Patient-controlled analgesia (PCA) following video-assisted thoracoscopic lobectomy: comparison of epidural PCA and intravenous PCA. Acta Anaesthesiol Taiwan. 2012 Sep;50(3):92-5. doi: 10.1016/j.aat.2012.08.004. Epub 2012 Sep 7.
- Background: PubMed 17095972Yoshioka M, Mori T, Kobayashi H, Iwatani K, Yoshimoto K, Terasaki H, Nomori H. The efficacy of epidural analgesia after video-assisted thoracoscopic surgery: a randomized control study. Ann Thorac Cardiovasc Surg. 2006 Oct;12(5):313-8.
- Background: PubMed 15784372Fernandez MI, Martin-Ucar AE, Lee HD, West KJ, Wyatt R, Waller DA. Does a thoracic epidural confer any additional benefit following video-assisted thoracoscopic pleurectomy for primary spontaneous pneumothorax? Eur J Cardiothorac Surg. 2005 Apr;27(4):671-4. doi: 10.1016/j.ejcts.2004.12.045.
- Derived from this study: PubMed 39323258Holm JH, Andersen C, Licht PB, Toft P, Zegers FD, Lambertsen KL, Brochner AC. Immunological effects of post-operative epidural analgesia versus oral opioids in VATS. Dan Med J. 2024 Sep 9;71(10):A09230582. doi: 10.61409/A09230582.
- Derived from this study: PubMed 37962202Holm JH, Andersen C, Toft P. Epidural analgesia versus oral morphine for postoperative pain management following video-assisted thoracic surgery: A randomised, controlled, double-blind trial. Eur J Anaesthesiol. 2024 Jan 1;41(1):61-69. doi: 10.1097/EJA.0000000000001921. Epub 2023 Nov 15.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Jimmy H Holm, MD principal investigator
Department of Anaesthesia and Intensive Care - Odense University Hospital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing Bupivacaine in epidural catheter, Fentanyl in epidural catheter and Oral Paracetamol in people with Lung Neoplasms and Pain, run by Odense University Hospital at 1 site in Denmark.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 27 Jun 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Denmark. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Intensity of pain (Self reported pain intensity) (time frame: 0-4 days). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02359175, which also lists 8 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Jun 2023.