Thoracic Paravertebral Block Ameliorates Postoperative Delirium in Geriatric Patients

Abstract

Objectives Thoracic surgery often causes postoperative delirium (POD) in geriatric patients. This study aimed to explore the effect of ultrasound-guided continuous thoracic paravertebral block (UG-TPVB) on POD in geriatric patients undergoing pulmonary resection. Methods Total 128 patients who underwent pulmonary resection were randomly allocated to either the conventional patient-controlled analgesia (PCA) group or the UG-TPVB group (n = 64 per group). The consumption of opioid agents (propofol and remifentanil), postoperative hospital stay, postoperative pulmonary atelectasis, postoperative nausea/vomiting, and postoperative itchiness were recorded. The diagnosis of delirium was dependent on the Nursing Delirium Screening Scale. The postoperative pain was assessed by visual analogue scale (VAS) score. The serum levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor-α were used to evaluate the postoperative neuroinflammation. Results The consumption of propofol and remifentanil, postoperative hospital stay, postoperative pulmonary atelectasis, postoperative nausea/vomiting, and postoperative itchiness in the UG-TPVB group were lower than that in the PCA group. Compared with the PCA group, the prevalence of POD was decreased in the UG-TPVB group. In addition, use of UG-TPVB not only reduced postoperative pain (VAS score) but also decreased postoperative neuroinflammation compared with PCA in geriatric patients undergoing pulmonary resection. Conclusions This study determined the benefits of UG-TPVB over PCA, providing an effectiveness approach to alleviate POD in geriatric patients undergoing pulmonary resection.

Effect of ultrasound‐guided thoracic paravertebral block on perioperative analgesia in elderly patients undergoing video‐assisted thoracic lobectomy in China: An interventional clinical randomized controlled trial

“…The advantages are that it can provide a more extensive and deeper thoracic nerve block, covering the pain‐sensitive areas of the thorax, reducing drug dosage and adverse reactions; it can also avoid affecting the movement of the diaphragm and cough reflex, reducing the risk of mechanical ventilation time and postoperative pulmonary infection. Previous studies have confirmed the application value of UG‐TPVB in lung cancer radical surgery 12–14 . It can improve the problems existing in traditional anesthesia management of elderly patients, such as excessive and side effects of opioids, respiratory dysfunction, cardiovascular complications, and so on.…”

Role of supplemental regional blocks on postoperative neurocognitive dysfunction after major non-cardiac surgeries: a systematic review and meta-analysis of randomized controlled trials

“…Five trials not fulfilling the inclusion criteria were excluded after full-text screening (online supplemental table 1). Twenty-six RCTs enrolling 4414 patients with a mean age of 70.69 years were included in this systematic review and meta-analysis 25–50. Of these, 2251 patients were enrolled in the RAB group, and 2163 were assigned to the control group.…”

“…Six trial authors included patients undergoing emergent/urgent procedures (fractures),27 33 42 43 47 49 whereas the rest included elective surgery patients. Two trial authors evaluated the effect of the combination of two or more blocks,28 41 whereas the rest of the trials used only a single block within the study. Most trial participants received general anesthesia, and neuraxial anesthesia was used as an anesthetic technique in two trials 33 49.…”

“…The incidence of PONV was significantly reduced with the usage of RAB (OR 0.59: 95% CI 0.46 to 0.77; p<0.0001; I 2 =0%; Tau 2 =0.00) (online supplemental figure 16). Among the other adverse effects, constipation was reported in four trials,33 37 42 43 pruritus,28 30 31 and atelectasis28 31 43 in three trials each, and respiratory depression25 29 and urinary retention36 43 in two trials each.…”

Comment on: “Thoracic Paravertebral Block Ameliorates POD in Geriatric Patients”

“…By a randomized controlled trial (RCT) of 128 geriatric patients undergoing pulmonary resection, Heng et al 1 showed that in comparison to conventional patient-controlled analgesia (PCA), continuous thoracic paravertebral block (CTPB) decreased the incidence of postoperative delirium (POD) and improved postoperative pain control. The findings of this study have potential clinical implications, but there are several methodological issues on which we wish to invite the authors to comment.…”