Effects of Abdominal Wall Blocks on Postoperative Delirium in Elderly Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Study

Abstract

Background Postoperative delirium (POD) seriously affects the rapid postoperative recovery of elderly patients. We investigated the effect of abdominal wall blocks on POD in elderly patients undergoing laparoscopic radical resection of colon cancer and underlying mechanisms. Material/Methods A total of 100 patients undergoing laparoscopic radical resection of colon cancer were randomly assigned to group C (control) and group R (regional nerve blocks). In group R, 20 mL of local anesthesia-mixed solution was injected into the bilateral transverse abdominis muscle plane and 10 mL was injected into the bilateral posterior sheath of the rectus abdominis muscle. In group C, the same amount of saline was used for nerve block. The consumption of propofol and remifentanil during surgery was recorded. Levels of serum interleukin (IL)-6 and highly sensitive C-reactive protein (hs-CRP) during surgery were evaluated. The Confusion Assessment Method for the Intensive Care Unit Scale and the Richmond Agitation-Sedation Scale were adopted to evaluate POD. Results The incidence of POD was lower in group R than in group C ( P =0.048). The consumption of propofol and remifentanil was significantly reduced in group R, compared with group C ( P <0.05). Compared with T0, serum IL-6 and hs-CRP levels in both groups were significantly increased at T1 and T2 ( P <0.05). Moreover, serum IL-6 and hs-CRP were lower at T1 and T2 in group R compared with group C ( P <0.05). Conclusions Abdominal wall blocks may alleviate POD in elderly patients undergoing laparoscopic surgery, which may be related to the reduction of anesthetic consumption and inflammatory response.

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.…”

“…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.…”

Comparison of Remimazolam and Propofol on Postoperative Delirium in Elderly Patients Undergoing Radical Resection of Colon Cancer: A Single-Center Prospective Randomized Controlled Study

“…Sample size was calculated using a web calculator ( http://powerandsamplesize.com/Calculators/ ). It has been reported that the incidence of delirium after radical resection of colon cancer is 24% [ 22 ]. The sample size was 1: 1, α=0.05, β=0.2, and the minimum sample size was estimated to be 43 cases in each group.…”