Ultrasound-guided continuous thoracic paravertebral block alleviates postoperative delirium in elderly patients undergoing esophagectomy

Jin, Liang; Yao, Rui; Heng, Lei; Pang, Bo; Sun, Fuguo; Shen, Ying; Zhong, Jun-Feng; Zhao, Panpan; Wu, Chenyu; Li, Bei-Ping

doi:10.1097/md.0000000000019896

Cited by 23 publications

(41 citation statements)

References 26 publications

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“…Theses results because TPVB protects cell-mediated immunity and reduces surgical neuroendocrine stress responses that stimulate the hypothalamic-pituitary-adrenal axis and sympathetic nervous system. Jin et al [30] conducted a study in elderly patients undergoing esophagectomy, they found that the plasma TNFα levels in the PVB group were significantly reduced compared with the patient-controlled analgesia group, 24, 48, and 72 h after surgery (P < 0.05) Consistent with our research, Buckley et al [31] compared the effect of PVB versus GA opioid anaesthesia on the immune response in patients undergoing breast cancer surgery, they found that patients received PVB maintained normal natural killer (NK) cell cytokine IL-10 function during the postoperative period (P = 0.9). However, in patients undergoing GA, IL-10 expression decreased after surgery (P = 0.001).…”

Section: Discussionmentioning

confidence: 99%

The effect of opioid free versus opioid based anaesthesia on breast cancer pain score and immune response

Aboalsoud

Arida

Sabry³

et al. 2021

Egyptian Journal of Anaesthesia

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Background: Modified radical mastectomy (MRM) with axillary clearance of lymph nodes was routinely performed under general anaesthesia with intra-and postoperative opioid analgesia. Recently, there has been a move toward opioid-free anesthesia (OFA) to appreciate the goals of hypnosis with amnesia and sympathetic stability without the adverse effects of opioids.The aim of this study was to evaluate the effect of OFA versus opioid-based anaesthesia (OBA) in patients with breast cancer, who had undergone unilateral MRM. The primary aims:• Pain intensity using the visual analogue scale in the first 24 h post-operatively.• Screening for post mastectomy neuropathic pain. The secondary aims:• Effect of opioid and surgical stress on the immune system.• Patient outcome including haemodynamic stability, patient satisfaction and occurrence of post-operative complications. Methods: Forty adult female patients scheduled for elective unilateral MRM were randomly divided into two groups (20 patients in each group): OFA and OBA. Results: There was statistically significant decrease in pain score at rest and on movement in the OFA group. Postoperative nausea and vomiting was significantly decreased in the OFA group (P = 0.04). Patients in the OFA group were more satisfied than those in the OBA group using verbal rating scale for satisfaction (P < 0.001). There was significant low incidence of neuropathic pain in the OFA group; also, we found significant changes in interleukin 10, tumour necrosis factor alpha and caspase 3 between the two groups. Conclusion: OFA is safe and effective in mastectomy as it decreases the pain score and the incidence of post mastectomy neuropathic pain; moreover, it also shows better immune response postoperatively.

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Section: Discussionmentioning

confidence: 99%

The effect of opioid free versus opioid based anaesthesia on breast cancer pain score and immune response

Aboalsoud

Arida

Sabry³

et al. 2021

Egyptian Journal of Anaesthesia

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“…The ultrasound-guided approach is a preferred method due to easy visualization and accurate puncture of the paravertebral space. USG-TPVB can effectively mitigate acute postoperative pain and chronic neuropathic pain, and the incidence of undesirable complications of this approach, such as nausea, vomiting, extradural hematoma, pulmonary complications, and nerve injury, is low [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Continuous Thoracic Paravertebral Infusion of Methylene Blue in the Treatment of Postherpetic Neuralgia: A Prospective, Randomized, Controlled Study

et al. 2021

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Introduction: Postherpetic neuralgia (PHN) is the most common complication of herpes zoster. Methylene blue (MB) is an inhibitor of nitric oxide synthesis with potentially analgesic and anti-inflammatory properties. Studies have demonstrated that thoracic paravertebral single MB injection is effective in treating chronic pain. However, there are rare reports of the efficacy of continuous thoracic paravertebral infusion of MB for pain management in PHN patients. The purpose of this study was to evaluate the therapeutic effects of continuous thoracic paravertebral infusion of MB on PHN. Methods: A total of 104 PHN patients were randomly divided into two groups: the control Mingxia Wang, Jinyuan Zhang and Li Zheng contributed equally to this work.

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“…Existing research has displayed that the plasma levels of inflammatory cytokines are significantly elevated in POD patients. 30 In this study, the serum levels of IL-1β, IL-6, and TNF-α after operation were reduced in the UG-TPVB group compared with the PCA groups, suggesting that UG-TPVB may alleviate POD by attenuating neuroinflammation in geriatric patients undergoing pulmonary resection. Moreover, an animal study has displayed that postoperative pain aggravates neuroinflammation and related delirium-like cognitive dysfunction.…”

Section: Discussionmentioning

confidence: 48%

Thoracic Paravertebral Block Ameliorates Postoperative Delirium in Geriatric Patients

Heng

Wang

et al. 2021

Thorac Cardiovasc Surg

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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.

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Ultrasound-guided continuous thoracic paravertebral block alleviates postoperative delirium in elderly patients undergoing esophagectomy

Abstract: Supplemental Digital Content is available in the text

Cited by 23 publications

References 26 publications

The effect of opioid free versus opioid based anaesthesia on breast cancer pain score and immune response

The effect of opioid free versus opioid based anaesthesia on breast cancer pain score and immune response

Ultrasound-Guided Continuous Thoracic Paravertebral Infusion of Methylene Blue in the Treatment of Postherpetic Neuralgia: A Prospective, Randomized, Controlled Study

Thoracic Paravertebral Block Ameliorates Postoperative Delirium in Geriatric Patients

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