Effect of bilateral paravertebral nerve block on cognitive function in elderly patients undergoing radical gastrectomy for gastric cancer: a prospective randomized double-blind controlled trial

Shang, Yue; Qi, Fuwei; Zheng, Zhong; Yang, Guangyu; Fei, Fan; Guo, Qiang; Zhu, Kangle

doi:10.1186/s12871-022-01764-9

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…Table 1 includes details about the RCTs, among them six RCTs ( Xie et al, 2019 ; Wei et al, 2020 , 2022 ; Chen et al, 2022 ; Heng et al, 2022 ; Dongjie et al, 2023 ) enrolled patients who underwent thoracoscopic surgery, one ( Jin L. et al, 2020 ) enrolled patients who underwent esophagectomy, one ( Shang et al, 2022 ) enrolled patients who underwent gastrectomy, and one ( Strike et al, 2019 ) enrolled patients who underwent Transapical Aortic Valve Replacement. Five RCTs compared the incidence of POD between PVB and non-PVB groups ( Strike et al, 2019 ; Jin L. et al, 2020 ; Heng et al, 2022 ; Wei et al, 2022 ; Dongjie et al, 2023 ), while other five RCTs, compared the incidence of DNR ( Xie et al, 2019 ; Wei et al, 2020 ; Chen et al, 2022 ; Heng et al, 2022 ; Shang et al, 2022 ). Only one study ( Chen et al, 2022 ) reported the incidence of POCD ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Only one study ( Chen et al, 2022 ) reported the incidence of POCD ( Table 2 ). Among the RCTs, five ( Strike et al, 2019 ; Jin L. et al, 2020 ; Wei et al, 2020 ; Heng et al, 2022 ) used continuous paravertebral analgesia post-operation, and four used the same intravenous analgesia PCA settings between PVB and non-PVB groups ( Xie et al, 2019 ; Chen et al, 2022 ; Shang et al, 2022 ; Dongjie et al, 2023 ). It’s worth noting that, except one study Chen et al, all participants elderly.…”

Section: Resultsmentioning

confidence: 99%

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Impact of paravertebral block on perioperative neurocognitive disorder: a systematic review and meta-analysis of randomized controlled trials

Wang,

Kang

et al. 2023

Front. Aging Neurosci.

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ObjectiveTo investigate whether paravertebral block reduces postoperative delirium (POD)/delayed neurocognitive recovery (DNR) in adults after major surgery with general anesthesia.MethodsFor this systematic review and meta-analysis, we searched online databases PubMed, EMBASE, CENTRAL, and Web of Science till March 19th, 2023 to examine studies which use paravertebral block (PVB) for perioperative neurocognitive disorder. Primary and secondary outcomes were identified for the incidence of perioperative neurocognitive disorder. We did not restrict the follow-up duration of the included studies. Statistical analysis was performed to calculate mean difference (MD), Odd ratios (OR) and CI between RCTs. The quality of the evidence was assessed with the Cochrane risk of bias tool. The registration number of the study in PROSPERO is CRD42023409502. PROSPERO is an international database of prospectively registered systematic reviews. Registration provides transparency in the review process and it helps counter publication bias.ResultsTotal 1,225 patients from 9 RCTs were analyzed. The incidence of POD [Odds Ratio (OR) = 0.48, 95% CI 0.32, 0.72; p = 0.0004; I2 = 0%] and DNR [OR = 0.32, 95% CI 0.13, 0.80; p = 0.01; I2 = 0%] were significantly reduced in PVB group. The analysis showed no significant differences in postoperative MMSE scores [MD = 0.50, 95% CI −2.14, 3.15; p = 0.71; I2 = 98%]. Paravertebral block analgesia reduces pain scores and/or opioid use after surgery. Additionally, blood pressure was significantly lower in the PVB group, intraoperatively [MD = −15.50, 95% CI −20.71, −10.28; p < 0.001; I2 = 12%] and postoperatively [MD = −5.34, 95% CI −10.65, −0.03 p = 0.05; I2 = 36%]. Finally, PVB group had significantly shorter hospital stays [MD = −0.86, 95% CI −1.13, −0.59; p < 0.001; I2 = 0%].ConclusionParavertebral block analgesia may prevent perioperative POD/DNR in patients undergoing major surgery. Further research with large sample sizes is required to confirm its effectiveness.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Impact of paravertebral block on perioperative neurocognitive disorder: a systematic review and meta-analysis of randomized controlled trials

Wang,

Kang

et al. 2023

Front. Aging Neurosci.

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“…[15][16] Recent years have seen the development of multimodal analgesia using nerve blocks as the primary mode of perioperative analgesia, which has been shown to effectively provide analgesia to promote early perioperative recovery. [17][18] Some studies have proposed an US-guided technique called "subcostal" TAPB for producing reliable analgesia for supraumbilical abdominal surgery, [13] and minimizing the perioperative stress response. [19] However, TAPB provides only somatic (i.e., abdominal wall) analgesia and not visceral analgesia.…”

Section: Discussionmentioning

confidence: 99%

Intertransverse process block versus subcostal transversus abdominis plane block in patients undergoing laparscopic radical gastrectomy: A prospective randomized controlled trial

Chen,

Zhou,

Wang

et al. 2024

Preprint

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Background：Laparoscopic radical gastrectomy has been reported to be associated with severe trauma and pain. This study compared the impact of ultrasound-(US)-guided, bilateral, double-injection intertransverse process block (ITPB) on postoperative analgesia with subcostal transversus abdominis plane block (TAPB) in patients who were undergoing laparoscopic radical gastrectomy. Methods：Sixty-twopatients (43 men and 19 women) aged 55–80 years who were undergoing laparscopic radical gastrectomy surgery under general anesthesia were included. These patients were randomised to either the ITPB group or the TAPB group. Patients in the ITPB group received a double-shot US-guided bilateral ITPB at the thoracic level T6/7, T9/10 level using ropivacaine (0.3%, 15mL). Patients in the TAPB group received bilateral subcostal TAPB using ropivacaine (0.3%, 30mL). All patients used a BIS-guided combined intravenous and inhalation anesthesia. The primary outcome was defined as postoperative morphine-equivalent consumption during the first 24 hours. Results： The study included 62 patients (31 in each group) for the analysis. A comparatively lesser amount of postoperative opioid consumption was observed in the ITPB group compared with the subcostal TAPB group within the first 24 h postoperatively (mean [standard deviation-(SD)] morphine-equivalent dose): 27.8 (5.7) mg vs31.2 (4.4) mg, P < 0.001. The ITPB group showed lower intraoperative opioid use, and significantly lower scores at rest and coughing at 6, 24 h postoperatively. The time to first requiring rescue analgesia was longer in the ITPB group than the subcostal TAPB group (mean [SD]): 13.2 (14.5) vs 6.5 (8.6) h, P = 0.031. The patients in the ITPB group exhibited a lower incidence of postoperative complications, including postoperative nausea and vomiting and relatively higher levels of satisfaction. Conclusion: This study showed that adouble-shot bilateral ITPB could reduce opioids consumption and achieve longer and better pain relief. Additionally, it promoted early postoperative activity and improved patient satisfaction.

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“…POCD is one of the most common complications in patients who have undergone laparoscopic gastric cancer surgery and is related to many factors, such as age, underlying disease, surgical and anesthesia methods, and surgical time. Anesthetic drugs can act on multiple targets in the brain, thereby affecting brain function, and the choice of drug is an important factor leading to postoperative POCD in patients[ 14 ]. MMSE is a commonly used scale for evaluating cognitive function in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Analgesic effect of ultrasound-guided bilateral transversus abdominis plane block in laparoscopic gastric cancer

Wang,

2023

World J Gastrointest Surg

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Postcholecystectomy bile duct injury (BDI) remains a devastating iatrogenic complication that adversely impacts the quality of life with high healthcare costs. Despite a decrease in the incidence of laparoscopic cholecystectomy-related BDI, the absolute number remains high as cholecystectomy is a commonly performed surgical procedure. Open Roux-en-Y hepaticojejunostomy with meticulous surgical technique remains the gold standard surgical procedure with excellent long-term results in most patients. As with many hepatobiliary disorders, a minimally invasive approach has been recently explored to minimize access-related complications and improve postoperative recovery. Since patients with gallstone disease are often admitted for a minimally invasive cholecystectomy, laparoscopic and robotic approaches for repairing postcholecystectomy biliary stricture are attractive. While recent series have shown the feasibility and safety of minimally invasive post-cholecystectomy biliary stricture management, most are retrospective analyses with small sample sizes. Also, long-term follow-up is available only in a limited number of studies. The principles and technique of minimally invasive repair resemble open repair except for the extent of adhesiolysis and the suturing technique with continuous sutures commonly used in minimally invasive approaches. The robotic approach overcomes key limitations of laparoscopic surgery and has the potential to become the preferred minimally invasive approach for the repair of postcholecystectomy biliary stricture. Despite increasing use, lack of prospective studies and selection bias with available evidence precludes definitive conclusions regarding minimally invasive surgery for managing postcholecystectomy biliary stricture. High-volume prospective studies are required to confirm the initial promising outcomes with minimally invasive surgery.

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Effect of bilateral paravertebral nerve block on cognitive function in elderly patients undergoing radical gastrectomy for gastric cancer: a prospective randomized double-blind controlled trial

Cited by 7 publications

References 8 publications

Impact of paravertebral block on perioperative neurocognitive disorder: a systematic review and meta-analysis of randomized controlled trials

Impact of paravertebral block on perioperative neurocognitive disorder: a systematic review and meta-analysis of randomized controlled trials

Intertransverse process block versus subcostal transversus abdominis plane block in patients undergoing laparscopic radical gastrectomy: A prospective randomized controlled trial

Analgesic effect of ultrasound-guided bilateral transversus abdominis plane block in laparoscopic gastric cancer

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