Effect of thoracic paravertebral block combined with general anesthesia on postoperative cognitive dysfunction in elderly patients undergoing pulmonary lobectomy

Abstract

Objective To evaluate the effect of thoracic paravertebral block combined with general anesthesia on postoperative cognitive dysfunction (POCD) in elderly patients undergoing pulmonary lobectomy. Methods A total of 120 elderly patients of both sexes, aged 65-81 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with New York Heart Association Ⅰor Ⅱ, were divided into 3 groups (n=40 each) using a random number table method: anesthesia group (group GA), epidural block combined with general anesthesia group (group EG), and paravertebral block combined with general anesthesia group (group PG). In group PG, paravertebral block was performed under ultrasound guidance, 0.25% ropivacaine 20 ml was injected after the paravertebral catheter was placed, and anesthesia was induced after confirming the plane of block.In group EG, epidural block was performed with 2% lidocaine 3 ml after epidural puncture was successfully performed at L6, 7 interspace, epidural 0.375% ropivacaine 8-15 ml was intermittently injected, and anesthesia was induced after confirming the height of block.Anesthesia was induced with IV midazolam 0.05-0.10 mg/kg, etomidate 0.3 mg/kg, sufentanil 0.4 μg/kg and rocuronium 0.6 mg/kg.The patients were tracheally intubated and mechanically ventilated.The development of POCD was recorded at 1 day before operation and 7 days after operation.Blood samples were collected from the internal jugular vein before anesthesia, at 15 min after skin incision and at 7 days after operation for determination of serum adiponectin (ADP) and S-100β protein concentrations. Results Compared with group GA, the incidence of POCD was significantly decreased, and the serum S-100β protein concentrations were decreased and serum ADP concentrations were increased at 15 min after skin incision and 7 days after operation in PG and EG groups (P<0.05). Compared with group EG, the incidence of POCD was significantly decreased, and the serum S-100β protein concentrations were increased and serum ADP concentrations were decreased at 15 min after skin incision and 7 days after operation in group PG (P<0.05). Conclusion Thoracic paravertebral block combined with general anesthesia induces better efficacy in decreasing the occurrence of POCD than general anesthesia alone or combination of epidural block and general anesthesia in elderly patients undergoing pulmonary lobectomy, which is related to the decreased concentrations of blood ADP in elderly patients undergoing pulmonary lobectomy. Key words: Nerve block; Pneumonectomy; Cognition disorders; Aged