Reducing Postoperative Delirium in Elderly Patients

Postoperative delirium (POD) is a common complication among elderly patients who have undergone surgery. This acute brain dysfunction can lead to confusion, agitation, and even hallucinations. One of the factors that contribute to POD is postoperative pain. Effective pain management can reduce the risk of POD, and one method that has been shown to be effective is a thoracic paravertebral block (TPVB). This technique can provide not only superior pain relief but also anti-neuroinflammatory effects, which can reduce the risk of POD.

Clinical trial

In a clinical study, researchers investigated whether the combination of nerve block with general anesthesia reduced the occurrence of POD following thoracoscopic lobectomy for early-stage non-small cell lung cancer. The study involved 338 elderly patients, aged 65-80 years, who underwent elective surgery for video-assisted thoracoscopic lobectomy (VATS). The patients were randomly assigned to either a patient-controlled intravenous analgesia group (PIA) or a patient-controlled paravertebral-block analgesia group (PBA). POD was evaluated using the 3-min diagnostic confusion assessment method.

The results of the study showed that delirium occurred in 28% of cases in the PIA group and 16.5% of cases in the PBA group. This means that the nerve block was associated with a lower incidence of postoperative delirium. Furthermore, the PBA group had a higher rate of overall recovery quality at day 7 after surgery compared with the PIA group. Pain intensity was also measured using the visual analog scale score, and it was found that TPVB provided superior pain relief compared with intravenous analgesia.

In addition to providing superior pain relief, the nerve block also has anti-neuroinflammatory effects. The study found that the incremental change in surgery-induced TNF-α and NFL (Neurofilament light) was greater in the PIA group than in the PBA group. This suggests that TPVB can inhibit the perioperative stress and inflammatory response, which can reduce the risk of POD.

The study concluded that TPVB is an effective method for reducing the risk of POD in elderly patients undergoing thoracoscopic lobectomy. As a component of multimodal analgesia, TPVB provides not only superior analgesic but also opioid-sparing effects. This means that patients who receive TPVB may require fewer opioids, which can reduce the risk of opioid-related complications.

Conclusion

Postoperative delirium is a common complication among elderly patients who have undergone surgery. Effective pain management can reduce the risk of POD, and one method that has been shown to be effective is the thoracic paravertebral block (TPVB). TPVB provides superior pain relief and anti-neuroinflammatory effects, which can reduce the risk of POD. This technique should be considered as part of multimodal analgesia for elderly patients undergoing thoracoscopic lobectomy.
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