Effect of TPVB on Postoperative Pain and Cognitive Function After VATS in Elderly Patients
Condition: Postoperative Cognitive Dysfunction; Acute Postoperative Pain; Chronic Postsurgical Pain
MeSH terms: Pain, Postoperative; Postoperative Cognitive Complications; Cognitive Dysfunction
Study type: Interventional

Summary: 
      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.
    

Detailed 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.
    

Intervention name(s): Measurement of cognitive function; Thoracic paravertebral block; The assessment of cognitive function
Intervention type(s): Behavioral; Procedure; Behavioral
Intervention description(s): Patients undergoing thoracoscopic surgery underwent general anesthesia.MMSE and MoCA were assessed at one day before surgery, one day after surgery, and three months after surgery; The patient was placed in lateral supine position, and the T5 spinous process was moved 2 to 3 cm 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; Participants were assessed for MMSE and MoCA at the same period as the group C
Other intervention name(s): assessment of POD; General anesthesia
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Prevention
Keywords: Thoracic paravertebral block; Cognitive function; Chronic Postsurgical Pain