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

Abstract

Background/importancePostoperative neurocognitive dysfunction (PNCD) is a frequent and preventable complication after surgery. The large high-quality evidence for the efficacy of supplemental regional analgesia blocks (RAB) for preventing PNCD is still elusive.ObjectiveThe objective of this meta-analysis was to evaluate the effect of RAB versus standard anesthesia care on the incidence of PNCD in adult patients undergoing major non-cardiac surgery.Evidence reviewPubMed, EMBASE, Scopus, and the Cochrane Central Registers of Controlled Trials (CENTRAL) were searched for randomized controlled trials (RCTs) from 2017 until June 2022. The primary outcome was the incidence of PNCD within 1 month of surgery. A random-effects model with an inverse variance method was used to pool results, and OR and mean differences were calculated for dichotomous and continuous outcomes. Various exploratory subgroup analyses were performed to explore the possibility of the association between the various patient, technique, and surgery-related factors. Grading of Recommendation, Assessment, Development, and Evaluation guidelines were used to determine the certainty of evidence.FindingsTwenty-six RCTs comprizing 4414 patients were included. The RAB group was associated with a significant reduction in the incidence of PNCD with an OR of 0.46 (95% CI 0.35 to 0.59; p<0.00001; I2=28%) compared with the control group (moderate certainty). Subgroup analysis exhibited that the prophylactic efficacy of RAB persisted for both delirium and delayed neurocognitive recovery.ConclusionsCurrent evidence suggests that supplemental RAB are beneficial in preventing PNCD in patients after major non-cardiac surgery.PROSPERO registration numberCRD42022338820

A novel nomogram for predicting the prolonged length of stay in post-anesthesia care unit after selective operation.

“…It is not surprising that ASA, major surgeries and operation duration are risk factors for PLOS. Major surgeries have been thought to cause in ammatory induced postoperative cognitive decline 19 , which is associated with poorer postoperative recovery, increased medical costs and higher mortality 20,21 .…”

“…Chernov and his colleagues conducted neuropsychological tests pre-operation and postoperation, which determined the association between regional cerebral blood ow reduction and poor cognitive performance 24 . For major surgery, regional nerve block combined with general anesthesia could effectively prevent cognitive decline 19 , which decreased incidence of PLOS. Whether the risk of delirium differs between general anesthesia with inhalants and total intravenous anesthesia remains controversial 25 .…”