PMID- 34979943
OWN - NLM
STAT- MEDLINE
DCOM- 20220323
LR  - 20240405
IS  - 1471-2253 (Electronic)
IS  - 1471-2253 (Linking)
VI  - 22
IP  - 1
DP  - 2022 Jan 3
TI  - Effect of general anesthesia with thoracic paravertebral block on postoperative 
      delirium in elderly patients undergoing thoracoscopic lobectomy: a 
      randomized-controlled trial.
PG  - 1
LID - 10.1186/s12871-021-01532-1 [doi]
LID - 1
AB  - BACKGROUND: Postoperative delirium (POD) is characterized by acute brain 
      dysfunction, especially in elderly patients. Postoperative pain is an important 
      factor in the development of delirium, and effective pain management can reduce 
      the risk of POD. Thoracic paravertebral block (TPVB) can effectively relieve 
      postoperative pain and inhibit the perioperative stress and inflammatory 
      response. We investigated whether the combination of TPVB with general anesthesia 
      reduced the occurrence of POD following thoracoscopic lobectomy. METHODS: A total 
      of 338 elderly patients, aged 65-80 years, who underwent elective surgery for 
      video-assisted thoracoscopic lobectomy (VATS) were randomly assigned to either a 
      patient-controlled intravenous analgesia group (PIA) or a patient-controlled 
      paravertebral-block analgesia group (PBA). POD was evaluated using the 3-min 
      diagnostic confusion assessment method (3D-CAM). The postoperative quality of 
      recovery (QoR) was assessed with Chinese version of QoR-40 scale. Pain intensity 
      was measured using the visual analog scale (VAS) score. Tumor necrosis factor-alpha 
      (TNF-alpha) and neurofilament light (NFL) levels were determined using enzyme-linked 
      immunosorbent assay (ELISA) kits. RESULTS: Delirium occurred in 47 (28%) of 168 
      cases in the PIA group and 28 (16.5%) of 170 cases in the PBA group (RR 1.7, 
      p = 0.03). PBA was also associated with a higher rate of overall recovery quality 
      at day 7 after surgery (27.1% vs. 17.3%, P = 0.013) compared with PIA. The 
      incremental change in surgery-induced TNF-alpha and NFL was greater in the PIA group 
      than PBA group (p < 0.05). CONCLUSION: Thoracic paravertebral block analgesia is 
      associated with lower incidence of postoperative delirium, probably due to its 
      anti-neuroinflammatory effects. Furthermore, as a component of multimodal 
      analgesia, TPVB provides not only superior analgesic but also opioid-sparing 
      effects. TRIAL REGISTRATION: The study was registered on the Chinese Clinical 
      Trial Registry Center ( www.chictr.org.cn ; registration number: ChiCTR 
      2,000,033,238 ) on 25/05/2018.
CI  - (c) 2021. The Author(s).
FAU - Wei, Wei
AU  - Wei W
AD  - Department of anesthesiology, cancer hospital and institute of Guangzhou medical 
      university, Guangzhuou, 510000, Guangdong, China.
FAU - Zheng, Xi
AU  - Zheng X
AD  - Department of anesthesiology, cancer hospital and institute of Guangzhou medical 
      university, Guangzhuou, 510000, Guangdong, China.
FAU - Gu, Yu
AU  - Gu Y
AD  - Department of anesthesiology, cancer hospital and institute of Guangzhou medical 
      university, Guangzhuou, 510000, Guangdong, China.
FAU - Fu, Wenting
AU  - Fu W
AD  - Department of anesthesiology, cancer hospital and institute of Guangzhou medical 
      university, Guangzhuou, 510000, Guangdong, China.
FAU - Tang, Chunlin
AU  - Tang C
AD  - Department of anesthesiology, cancer hospital and institute of Guangzhou medical 
      university, Guangzhuou, 510000, Guangdong, China.
FAU - Yao, Yonghua
AU  - Yao Y
AD  - Department of anesthesiology, cancer hospital and institute of Guangzhou medical 
      university, Guangzhuou, 510000, Guangdong, China. 726832646@qq.com.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20220103
PL  - England
TA  - BMC Anesthesiol
JT  - BMC anesthesiology
JID - 100968535
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anesthesia, General/*methods
MH  - China/epidemiology
MH  - Comorbidity
MH  - Delirium/*epidemiology
MH  - Female
MH  - Humans
MH  - Lung/surgery
MH  - Lung Neoplasms/*surgery
MH  - Male
MH  - Nerve Block/*methods
MH  - Pain, Postoperative/drug therapy/epidemiology
MH  - Postoperative Complications/*epidemiology
MH  - Thoracic Surgery, Video-Assisted/*methods
PMC - PMC8722018
OTO - NOTNLM
OT  - Postoperative delirium
OT  - Postoperative quality of recovery
OT  - Thoracic paravertebral block
OT  - Video-assisted thoracoscopic lobectomy
COIS- The authors have no conflicts of interest to disclose.
EDAT- 2022/01/05 06:00
MHDA- 2022/03/24 06:00
PMCR- 2022/01/03
CRDT- 2022/01/04 05:36
PHST- 2021/03/30 00:00 [received]
PHST- 2021/11/29 00:00 [accepted]
PHST- 2022/01/04 05:36 [entrez]
PHST- 2022/01/05 06:00 [pubmed]
PHST- 2022/03/24 06:00 [medline]
PHST- 2022/01/03 00:00 [pmc-release]
AID - 10.1186/s12871-021-01532-1 [pii]
AID - 1532 [pii]
AID - 10.1186/s12871-021-01532-1 [doi]
PST - epublish
SO  - BMC Anesthesiol. 2022 Jan 3;22(1):1. doi: 10.1186/s12871-021-01532-1.