Effects of Thoracic Paravertebral Block Combined With S-ketamine on Postoperative Pain and Cognitive Function After Thoracoscopic Surgery
Condition: Postoperative Cognitive Dysfunction
MeSH terms: Pain, Postoperative; Postoperative Cognitive Complications; Cognitive Dysfunction
Study type: Interventional

Summary: 
      To investigate the effect of ultrasound-guided thoracic paravertebral nerve block combined
      with intraoperative infusion of s-ketamine on postoperative acute pain and cognitive function
      in patients with thoracoscopic surgery
    

Detailed description: 
      A total of 120 patients who were admitted to Qinhuangdao First Hospital for and divided into
      control group (group C ), thoracic paravertebral nerve block combined with full Anesthesia
      group (group TA), thoracic paravertebral nerve block combined with intraoperative infusion of
      s-ketamine group ( group TE). 40 cases in each group. Group C received general anesthesia,
      group TA received 0.375% ropivacaine 20ml thoracic paravertebral nerve block combined with
      general anesthesia under ultrasound guidance after anesthesia induction, and group TE
      received s-ketamine anesthesia induction dose of 0.3 mg/kg on the basis of TA group.
      Anesthesia maintenance dose of 0.2ug/kg/h was pumped to 30min before the end of the
      operation. The MAP(Mean Artery Pressure) and HR(Heart Rate) of the three groups were recorded
      before surgery (T1), during the surgery (T2), immediately after surgery (T3). Compare the
      VAS（Visual analogue scale）in the ten minuses after extubation and one day afte surgery .The
      cognitive function of the three groups were evaluated by the Mini Mental State Scale (MMSE)
      on one day before surgery , one day after surgery , and three months after surgery . Compare
      the incidence of Postoperative Cognitive Disfuntion（ POCD） among the three groups.
    

Intervention name(s): Thoracic paravertebral block; Esketamine; Measurement of cognitive function; The assessment of cognitive function
Intervention type(s): Procedure; Drug; Behavioral; Behavioral
Intervention description(s): The patient was placed in lateral supine position, and the T5 spinous process was moved 2 to 3cm laterally to the operative side as the puncture point, and the pleura and T5 transverse process were observed, and the paraspinal space was observed on the lower lateral side of the transverse process. Using in-plane technique, the needle position was adjusted under ultrasound visualization to reach the paraspinal space. 20ml 0.375% ropivacaine was injected into the suction syringe when there was no blood or gas, and the drug liquid could be seen spreading outside the pleura. "Landscape sign" appeared, indicating successful block; Group TE received s-ketamine anesthesia induction dose of 0.3 mg/kg on the basis of TA group. Anesthesia maintenance dose of 0.2ug/kg/h was pumped to 30min before the end of the operation; Patients undergoing thoracoscopic surgery underwent general anesthesia.MMSE was assessed at one day before surgery, one day after surgery, and three months after surgery; Participants were assessed for MMSE at the same period as the group C
Other intervention name(s): General anesthesia; Combined general anesthesia; assessment of POCD
Intervention MeSH terms: Anesthetics; Esketamine
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Prevention
Keywords: Esketamine; Thoracic paravertebral block; Cognitive function