Effects of thoracic paravertebral nerve block on postoperative pain and postoperative delirium in elderly patients undergoing thoracoscopic lobectomy

Abstract

Objectives: To evaluate the effects of ultrasound-guided thoracic paravertebral nerve block on perioperative pain and postoperative delirium in elderly patients undergoing thoracoscopic lobotomy. Methods: Patients aged 60 to 80 years who underwent the surgery of thoracoscopic lobectomy were selected; ASA grades I to III and New York Heart Association (NYHA) grades I to II. Patients were randomly divided into two groups: group C (group Compaired) and group T (group Thoracic Paravertebral Nerve Block TPVB). Patients in group T received ultrason-guided TPVB while those in group C didn’t received TPVB. Postoperative patient-controlled intravenous analgesia was administered to all the patients. The consumption of intraoperative opioids, cases of hipoxemia, operative time, and extubation time was also recorded. Pain scores (static and dynamic) were assessed at 2, 4, 6, 24, 48, 72, 96, and 120 hours point after the operation. Pain scores, occurrence of postoperative delirium occurrence, postoperative complications, total amount of analgesic drugs, length of hospital stay, rescue analgesic requirement, and side effects were recorded within 5 days. Results: Intraoperative dosages of sufentanil and remifentanil were significantly lower in group T (Table 1). The postoperative recovery time in group T was significantly shortened (Table 1). The VAS pain scores of group T at 2, 4, 6, and 24 hours after surgery were much lower. The consumption of intraoperative opioids, number of rescue analgesic requirements, and the occurrence of postoperative delirium incidence in group T was significantly reduced (Table 2). There were no differences in hipoxemia events, postoperative nausea, vomiting and pulmonary complications between the two groups (Table 2). Table 1Sufentanil and remifentanil consumption. The total amount of Group C (n = 105) Group T (n = 103) P value Sufentanil (µg/kg) 0.91 ± 0.26 0.68 ± 0.17** <.01 Remifentanil (µg/kg) 18.8 ± 2.9 14.7 ± 1.5** <.01 Table 2Postoperative static VAS pain score. 2 h 4 h 6 h 24 h 48 h 72 h 96 h 120 h Group C (n = 105) 3.6 ± 1.1 3.7 ± 1.0 2.9 ± 0.9 2.6 ± 1.3 1.4 ± 0.8 0.6 ± 0.6 0.1 ± 0.3 0 Group T (n = 103) 2.6 ± 0.9** 2.5 ± 0.8** 2.1 ± 0.7** 1.7 ± 0.7** 1.2 ± 0.8 0.7 ± 0.7 0 ± 0.22 0 P <.01 <.01 <.01 <.01 .129 .571 .128 Conclusion: Preoperative ultrasound-guided thoracic paravertebral nerve block (TPVB) can obviously decrease the intraoperative and postoperative opioids consumption, shorten the recovery time, reduce the number of rescue analgesia and the incidence of postoperative delirium in elderly patients undergoing thoracoscopic lobotomy.

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

“…Five RCTs studies ( 31 , 32 , 34 , 37 , 38 ) were included in our postoperative seven-day delirium analysis. We included the delirium incidence rate closest to the seventh postoperative day.…”

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

“…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 ).…”

“…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.…”

“…In total of 11 trials reported rest pain scores, six studies reported pain scores after 24 h ( Jin L. et al, 2020 ; Wei et al, 2020 , 2022 ; Chen et al, 2022 ; Heng et al, 2022 ; Dongjie et al, 2023 ) ( Figure 6 ), while five studies ( Strike et al, 2019 ; Jin L. et al, 2020 ; Wei et al, 2020 , 2022 ; Dongjie et al, 2023 ) reported pain scores at 48 h. Further analysis revealed that PVB effectively reduced pain at 24 h [MD = −1.30, 95% CI −2.36, −0.25; p = 0.02; I 2 = 100%] and 48 h [MD = −0.97, 95% CI −1.85, −0.10; p = 0.03; I 2 = 99%] after surgery. Egger’s test identified no significant publication bias ( p = 0.058; p = 0.266).…”

Metformin Use in Type 2 Diabetics and Delirium After Noncardiac Surgery: A Retrospective Cohort Analysis

“…1 It is characterized by a fluctuating level of consciousness, and is self-limited, usually resolving over a matter of days. 2 Established risk factors include advanced age, 3,4 cardiac surgery, 5 neurosurgery, 6 and use of multiple medications. 7 The incidence of delirium varies widely but seems to be less common now than previously reported.…”