Effect of TPVB on Postoperative Pain and Cognitive Function After VATS in Elderly Patients

The First Hospital of Qinhuangdao

Status: Completed

Conditions: Acute Postoperative Pain; Chronic Postsurgical Pain; Postoperative Cognitive Dysfunction

Treatments: Behavioral: The assessment of cognitive function; Behavioral: Measurement of cognitive function; Procedure: Thoracic paravertebral block

Study type: Interventional

Funder types: Other

Identifiers

NCT05364216

20220503

Details and patient eligibility

About

To investigate the effect of ultrasound-guided thoracic paravertebral nerve block on postoperative acute and chronic pain and cognitive function in elderly patients with thoracoscopic partial lung resection.

Full description

A total of 92 patients who were admitted to Qinhuangdao First Hospital for and divided into control group (group C ), thoracic paravertebral nerve block combined with general anesthesia group (group T).

Group C received general anesthesia, and group T received 0.375% ropivacaine 20 ml of thoracic paravertebral nerve block combined with general anesthesia after induction of anesthesia. SBP（Systolic Blood Pressure）/DBP （Diastolic Pressure）and HR（Heart Rate） of the two groups were recorded before anesthesia induction (T1), at the time of intubation (T2), at the beginning of surgery (T5), immediately after surgery (T6), and five minutes after extubation (T7) . rScO2（Regional cerebral oxygen saturation） was recorded in both groups at (T1), five minutes after induction(T3), five minutes after single lung ventilation on lateral recumbent(T4), (T6), (T7). The incidence of acute and chronic pain after surgery was compared between the two groups by NRS（Numerical Rating Scale）after extubation , one day after surgery, and three months after surgery.

The cognitive function of the two groups was assessed with the Mini Mental State Scale (MMSE) and the Montreal Cognitive Assessment Scale (MoCA-Beijing) on the day before , one day after and three months after surgery, comparing the incidence of PND (postoperative cognitive dysfunction) between the two groups.Analyze whether paravertebral block can reduce the incidence of POD by improving brain oxygen saturation.

Enrollment: 92 patients

Sex: All

Ages: 60 to 90 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• BMI less than 30 kg/m2
• American Society of Anesthesiologists (ASA) grades I-III
• The score of Mini Mental state examination≥24
• The score of Montreal Cognitive Assessment-Beijing Scale≥26

Exclusion criteria

• Patients with heart, lung, brain and other vital organ disorders
• The score of Mini Mental state examination≤23
• The score of Montreal Cognitive Assessment-Beijing Scale≤25
• Preoperative psychiatric disorders or long-term use of drugs affecting the psychiatric system
• Have severe visual, hearing, speech impairment or other inability to communicate with the visitor
• Have contraindications to thoracic parathymic block
• Refuse to sign informed consent

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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92 participants in 3 patient groups

Group C

Other group

Description:

The general anesthesia was used.In this group, cognitive function was evaluated by MMSE and MoCA scale on one day before surgery, one day after surgery, and three months after surgery. Acute postoperative pain was was evaluated by VAS after extubation , one day after surgery, Chronic postsurgical pain was evaluated by VAS on three months after surgery.

Treatment:

Behavioral: Measurement of cognitive function

Group T

Experimental group

Description:

Group T received 0.375% ropivacaine 20ml thoracic paravertebral nerve block combined with general anesthesia under ultrasound guidance after anesthesia induction.

Treatment:

Procedure: Thoracic paravertebral block

Behavioral: Measurement of cognitive function

Non-surgical controls

Other group

Description:

Age and sex-matched community people are included for three sessions of MMSE test evaluation for calculation of POD incidence as normal control to in Z value calculation of POD incidence to rule out learning effect.

Treatment:

Behavioral: The assessment of cognitive function