Effect of Preoperative Thoracic Paravertebral Blocks on Emergence Agitation During Tracheal Extubation: A Randomized Controlled Trial

Abstract

ObjectiveThis study aims to compare the effects of preoperative thoracic paravertebral blocks (TPVB) with intercoastal nerve blocks (ICNB) on emergence agitation (EA) during tracheal extubation in patients who underwent thoracoscopic lobectomy.Design, Setting, and ParticipantsA randomized clinical trial was conducted in patients undergoing thoracoscopic lobectomy at Beijing Chest Hospital between June 2019 and December 2020.InterventionsPatients were randomly assigned 1:1 to receive either ultrasound-guided preoperative TPVB or ICNB.Main Outcomes and MeasuresThe primary outcome was the occurrence of emergency agitation, which was evaluated by Aono’s four-point scale (AFPS). Secondary outcomes included hemodynamics [mean arterial pressure (MAP) and heart rate (HR)]; and post-operative pain intensity [visual analog scale (VAS), Ramsay sedation score (RSS), and patient-controlled analgesia (PCA) demand times].ResultsAmong the 100 patients aged 55–75 years old, 50 were randomized to each group; 97 patients completed the trial. Compared to the ICNB group, the occurrence of EA in the TPVB group was significantly lower [31.3% (15/48) vs. 12.2% (6/49), relative risk = 1.276, 95% CI: 1.02–1.60, P = 0.028]. For patients in the TPVB group, the MAP and HR at 5, 10, and 30 min after extubation were significantly lower; the intraoperative details including emergence time, extubation time, and consumption of sufentanil were significantly shorter than that in the ICNB group. Additionally, patients in the TPVB group showed significantly lower VAS at rest or coughing and significantly lower RSS at 60 and 240 min after extubation than patients in the ICNB group (all P < 0.05).ConclusionPreoperative TPVB was associated with less EA during tracheal extubation when compared with ICNB in patients undergoing thoracoscopic lobectomy.Clinical Trial Registration[http://www.chictr.org.cn/index.aspx], identifier [ChiCTR1900023852].

Effect of thoracic paravertebral nerve block on delirium in patients after video-assisted thoracoscopic surgery: a systematic review and meta-analysis of randomized controlled trials

“…In this study, a total of eight studies conducted thoracoscopic lung lobe resection under general anesthesia combined with TPVB (31)(32)(33)(34)(35)(36)(37)(38), while another study performed thoracoscopic surgery under general anesthesia combined with TPVB (39). In seven of the studies, the postoperative analgesia regimen employed Patient-Controlled Intravenous Analgesia (PCIA).…”

“…A single study was categorized as posing a low risk of bias (35), whereas seven studies elicited some level of concern regarding bias risk (31)(32)(33)(36)(37)(38)(39), and another study was flagged for high bias risk (34), as depicted in Figure 2. The quality assessment of the evidence is outlined in Figure 3.…”

“…Six RCTs studies (32)(33)(34)(35)(36)39) were included in our postoperative three-day delirium analysis. We incorporated the delirium incidence rate (1-3 days) from each study that was closest to the third day.…”

“…An analysis of post-surgical first-day pain scores was conducted, omitting a study with a divergent pain assessment approach (39). Six RCTs were integrated into our evaluation (31)(32)(33)(34)(35)(36). When performing a meta-analysis on the remaining seven studies that employed VAS pain scores, we observed that on the first day postoperatively, the TPVB group had lower pain scores compared to the control group (g: −1.52, 95% CI [−2.87, −0.17], p = 0.03, I 2 = 98.50%) (Supplementary Appendix 4).…”