Abstract
BackgroundQuadratus lumborum block (QLB) is a novel and effective postoperative analgesia method for abdominal surgeries. However, whether QLB can affect early postoperative cognitive function by inhibiting surgical traumatic stress and the inflammatory response remains unclear. This study aimed to explore the effect of QLB on postoperative cognitive function in elderly patients undergoing laparoscopic radical gastrectomy.MethodsSixty-four elderly patients who underwent laparoscopic radical gastrectomy were randomly divided into the QLB group (Q group, n = 32) and control group (C group, n = 32). The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to measure cognitive function 1 day before and 7 days after surgery. Postoperative cognitive dysfunction (POCD) was defined as a decline of ≥ 1 SD in both tests. The visual analog scale (VAS) scores 6 h (T1), 24 h (T2), and 48 h (T3) after surgery were measured. The serum levels of high mobility group box protein 1 (HMGB1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were evaluated 1 day before surgery (baseline), and 1 day (day 1) and 3 days after surgery (day 3). The intraoperative remifentanil dosage, sufentanil consumption 24 h after surgery, recovery time from anesthesia, and adverse effects were also compared.ResultsPOCD was present in two patients in the QLB group and eight patients in the C group 7 days after surgery (6.7 % vs. 27.6 %, P = 0.032). The MMSE and MoCA scores were similar in both groups preoperatively, and the two scores were higher in the QLB group than in the C group 7 days after surgery (P < 0.05). The VAS scores were significantly lower in the Q group at all times after surgery (P < 0.05). Compared with the C group, the levels of HMGB1, TNF-α, and IL-6 were significantly decreased 1 and 3 days after surgery in the QLB group (P < 0.05). The remifentanil consumption intraoperatively and sufentanil 24 h postoperatively were significantly lower in the QLB group (P < 0.05). The recovery time from anesthesia was shorter in the QLB group (P < 0.05). No severe adverse effects occurred in either group.ConclusionsQLB could improve postoperative cognitive function in elderly patients undergoing laparoscopic radical gastrectomy. This may be related to the suppression of the inflammatory response after surgery.Trial registrationChictr.org.cn identifier ChiCTR1900027574 (Date of registry: 19/11/2019, prospectively registered).
Highlights
Quadratus lumborum block (QLB) is a novel and effective postoperative analgesia method for abdominal surgeries
Sixty-four patients were randomly divided into two groups using a random number generator: the QLB group (Q group) and control group (C group)
Two patients were excluded from the Q group due to an unsuccessful quadratus lumborum block (n = 1) and being unexpectedly admitted to the intensive care unit (ICU; n = 1)
Summary
Quadratus lumborum block (QLB) is a novel and effective postoperative analgesia method for abdominal surgeries. This study aimed to explore the effect of QLB on postoperative cognitive function in elderly patients undergoing laparoscopic radical gastrectomy. Despite the advantages of a small incision, laparoscopic radical gastrectomy can lead to persistent postoperative pain, which may increase the incidence of postoperative complications, such as POCD, and seriously affect patient prognosis and quality of life. Many risk factors, such as insufficient postoperative analgesia, limited mobility after surgery, improper use of drugs, the release of inflammatory mediators, and stress response, can contribute to the development of POCD [2]. Surgery leads to a systemic inflammatory response, and inflammatory mediators, such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and interleukin-1β (IL-1β), are released into the plasma, resulting in POCD [3]
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