Key result
General anesthesia combined with thoracic paravertebral blockade was associated with fewer postoperative pulmonary complications compared to general anesthesia alone.
Why the study?
Although thoracic paravertebral blockade reduces thoracic surgery pain, whether this pain reduction reduces pulmonary complications in elderly patients remains unconfirmed.
Does general anesthesia combined with thoracic paravertebral blockade reduce postoperative pulmonary complications in geriatric patients undergoing thoracic surgery?
Cohort (n=154)
No
Does general anesthesia combined with thoracic paravertebral blockade reduce postoperative pulmonary complications in geriatric patients undergoing thoracic surgery?
General anesthesia combined with thoracic paravertebral blockade may reduce postoperative pulmonary complications in geriatric patients undergoing thoracic surgery.
Answers are grounded in this paper and cite their sources.
GA-TPVB was associated with fewer PPCs in geriatric thoracic surgery; hypothesis-generating pending randomized confirmation.
BACKGROUND: While it is known that thoracic paravertebral blockade (TPVB) could reduce pain undergoing thoracic surgery, it has not been confirmed whether this reduction in pain reduces pulmonary complications in an elderly population. METHODS: We performed a monocentric retrospective analysis for a prospectively collected patients receiving thoracic surgery with or without intraoperative TPVB between November 7, 2018 and April 1, 2019, at Shanghai Chest Hospital. Whether or not to use TPVB depending on anesthesiologists' preference, the chances of harm and benefit of each patients after discussed with their anesthetist. Chest wall resection, bilateral lung resection, conversion to thoracotomy and ipsilateral reoperation were excluded. A total of 154 patients with lung operations were included in the final analysis, 34 of whom received general anesthesia combined with TPVB (GA-TPVB). The primary outcome was the incidence of postoperative pulmonary complications (PPCs). The secondary outcomes were the incidence of cardiovascular and other complications, required analgesia in post anesthesia care unit (PACU), patient controlled analgesia (PCA) pressing frequency in 24h, chest tube duration, ICU stay and the hospital length of stay (LOS). RESULTS: 3%, P=0.021). TPVB could reduce the rate of required analgesia in PACU, PCA pressing frequency in 24 h and chest tube duration. However, there were no significant differences on the rate of cardiovascular and other complications, ICU stay and LOS between the two groups (P>0.05). Multivariable logistic regression analysis identified preoperative DLCO% ≥92% (OR =0.293, P=0.006), duration of surgery <75 min (OR =0.278, P=0.008) and GA-TPVB (OR =0.270, P=0.048) was associated with fewer PPCs. CONCLUSIONS: Our study shows that general anesthesia combined with TPVB may reduce PPCs by reducing postoperative pain in geriatric patients undergoing thoracic surgery compared with general anesthesia alone. TRIAL REGISTRATION: Chinese Clinical Trial Registry number, ChiCTR1800019526. Registered on Nov 7, 2018.
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Tong et al. (2019) conducted a cohort in Geriatric patients undergoing thoracic surgery (n=154). Thoracic paravertebral blockade (TPVB) combined with general anesthesia vs. General anesthesia alone was evaluated on Incidence of postoperative pulmonary complications (PPCs) (OR 0.270, p=0.048). General anesthesia combined with thoracic paravertebral blockade was associated with fewer postoperative pulmonary complications compared to general anesthesia alone.
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