Effects of thoracic paravertebral block on postoperative cognitive functions among elderly patients undergoing thoracoscopic radical surgery for lung cancer.

[OBJECTIVE] To investigate the thoracic paravertebral block (TPVB)on postoperative cognitive functions among elderly patients undergoing thoracoscopic radical surgery for lung cancer.

[METHODS] Ninety patients who underwent thoracoscopic radical surgery for lung cancer were selected and divided into an experimental group and a control group, with 45 cases in each group. The patients in the experimental group were given TPVB under ultrasound guidance combined with general anesthesia, while the patients in the control group were given conventional general anesthesia. The clinical data, dosage of anesthetic drugs, blood glucose levels, hemodynamic parameters, incidence of adverse reactions, and cognitive function scores [evaluated by the mini-mental state examination (MMSE) scale and the Montreal cognitive assessment (MoCA) scale] of the two groups of patients were compared one day before and 24 h after the surgery.

[RESULTS] The dosage of anesthetic drugs was significantly lower in the experimental group than in the control group for propofol, remifentanil, and sufentanil (all  0.00). Blood glucose and hemodynamics: One hour after the start of the surgery, at the end of the surgery, and at 6 and 24 h postoperatively, the blood glucose levels in the experimental group were significantly lower than those in the control group ( 0.00,  0.01,  0.01,  0.02, respectively), heart rate (HR) in the experimental group was significantly lower than that in the control group ( 0.00,  0.00,  0.01,  0.02, respectively), and mean arterial pressure (MAP) in the experimental group was significantly lower than that in the control group ( 0.00,  0.00,  0.01,  0.01, respectively). Cognitive function scores: There was no statistical difference in MMSE and MoCA scores between the two groups before the surgery (MMSE:  0.42; MoCA:  0.39). At 24 h postoperatively, the MMSE score in the experimental group was 26.85 ± 4.12, significantly higher than that in the control group of 24.63 ± 3.61 ( 0.02), and the MoCA score in the experimental group was 26.11 ± 2.03, significantly higher than that in the control group of 23.04 ± 1.86 ( 0.01). Adverse reactions: The incidence of postoperative adverse reactions in the experimental group was 15.56%, significantly lower than that in the control group of 28.89% (χ²=4.117,  0.04).

[CONCLUSION] TPVB under ultrasound guidance can effectively maintain the stability of patients’ hemodynamics and blood glucose levels, improve patients’ cognitive function, and reduce the incidence of postoperative adverse reactions.