Postoperative Cognitive Dysfunction
Conditions
Keywords
Esketamine, Thoracic paravertebral block, Cognitive function
Brief 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.
Interventions
PROCEDUREThoracic paravertebral block
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
DRUGEsketamine
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
BEHAVIORALMeasurement of cognitive function
Patients undergoing thoracoscopic surgery underwent general anesthesia.MMSE was assessed at one day before surgery, one day after surgery, and three months after surgery
BEHAVIORALThe assessment of cognitive function
Participants were assessed for MMSE at the same period as the group C
Sponsors
The First Hospital of Qinhuangdao
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
45 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* 18-24kg/m2 * American Society of Anesthesiologists (ASA) grades I-III * The score of Mini Mental state examination≥24
Exclusion criteria
* Patients with heart, lung and other vital organ disorders * The score of Mini Mental state examination≤23 * Preoperative psychiatric disorders or long-term use of drugs affecting the psychiatric system * Have severe visual, hearing, speech impairment or other inability to communicate with the visitor * Refuse to sign informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of POCD at one day after surgery | One day after surgery | The MMSE difference between the patients on the day before surgery and one day after surgery was compared and substituted into the formula.The formula of Z-scoring method is Z= (XC-X) /SDXC, where X refers to the change value of patients' MMSE score at one day before surgery and one day after surgery. XC is the mean change value of the non-surgical control group at the same time, and SDXC is the standard deviation of the change value of the non-surgical control group. Finally, the Z-value at one day after surgery is calculated respectively. If the value of Z is ≥1.96, the patient is considered to have developed POCD |
| Incidence of POCD at three months after surgery | Three months after surgery | The MMSE difference between the patients on the day before surgery and three months after surgery was compared and substituted into the formula.The formula of Z-scoring method is Z= (XC-X) /SDXC, where X refers to the change value of patients' MMSE score at one day before surgery and three months after surgery. XC is the mean change value of the non-surgical control group at the same time, and SDXC is the standard deviation of the change value of the non-surgical control group. Finally, the Z-value at three months after surgery is calculated respectively. If the value of Z is ≥1.96, the patient is considered to have developed POCD |
| Change in pain assessed by Visual Analogue Scale | Ten minutes after extubation | Divide the ruler into 10 equal parts, with 0-2 indicating no pain, 3-5 indicating mild pain, 6-8 indicating moderate pain, and 9-10 indicating severe pain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Anesthetic drug | during the surgery | The dosage of remifentanil and propofol in different groups were recorded |
| The change of MAP | pre-surgery;during the surgery;immediately after surgery | The change of Mean Arterial Pressure(MAP) among the three groups |
| The change of HR | pre-surgery;during the surgery;immediately after surgery | The change of Heart Rate(HR) among the three groups |
Countries
China
Outcome results
None listed