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

Frontiers in Aging Neuroscience

Aging Neuroscience

Lu Wang¹  Wanli Kang²  Wei Liu³  Guangkuo Gao³  Bin Chen³  Fei Wang³  Tao Liu³ 

[1] Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital Capital Medical University, Beijing, China;Department for Disease Prevention and Control, Beijing Chest Hospital, Capital Medical University, Beijing, China;Department of Anesthesiology, Beijing Chest Hospital, Capital Medical University, Beijing, China;

关键词: paravertebral block;    surgery;    perioperative neurocognitive disorder;    postoperative delirium;    delayed neurocognitive recovery;    postoperative pain;   

DOI  :  10.3389/fnagi.2023.1237001

 received in 2023-06-08, accepted in 2023-08-28,  发布年份 2023

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

Unknown   
Copyright © 2023 Wang, Wang, Kang, Gao, Liu, Chen and Liu.