Effect of bilateral paravertebral nerve block on cognitive function in elderly patients undergoing radical gastrectomy for gastric cancer: a prospective randomized double-blind controlled trial

Abstract

Objective: To investigate the effect of a bilateral paravertebral block (PVB) on cognitive function in elderly patients undergoing radical gastrectomy for gastric cancer. Methods: Sixty patients (40 men and 20 women) aged 65–80 undergoing radical gastrectomy surgery under general anaesthesia were included and randomly assigned to either the PVB group or the control group. Patients in the PVB group had before incision a single-shot ultrasound-guided bilateral PVB at the T8 level with 20 mL of ropivacaine 0.375%, while patients in the control group had no block. Patients in both groups had a BIS-guided total intravenous anaesthesia with propofol and remifentanil infusions. Postoperative cognitive function assessed by the mini-mental state examination (MMSE) and NSE (neuron-specific enolase) was the primary outcome. Results: The awareness time in group PVB was shorter than that in the group C, and the propofol and remifentanil dosages were less than that in group C (P<0.001, P = 0.007, respectively). Furthermore, the change of the MMSE score and the NSE concentration was significant from day0 to day1 and day1 to day2. (P<0.001). Conclusion: A single-shot bilateral PVB active throughout radical gastrectomy for gastric cancer reduces the needs for general anaesthetic agents and improve postoperative recovery, along with a surrogate evidence for neuroprotective effects. Trial registration: ChiCTR2200060088. Registered 18 May 2022.