The effects of paravertebral blockade usage on pulmonary complications,atrial fibrillation and length of hospital stay following thoracoscopic lung cancer surgery |
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| Institution: | 1. Department of Anesthesiology, Shanghai Children''s Medical Center, School of Medicine, Shanghai Jiao Tong University, China;2. Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China;1. Department of Anesthesiology, Guangdong Provincial People''s Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, People''s Republic of China;2. Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China;3. Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, China;1. Department of Anesthesiology and Critical care, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019, India;2. Department of Neurosurgery, All India Institute of Medical sciences, Bhubaneswar, Odisha 751019, India;1. Mount Sinai Medical Center, Miami Beach, FL, United States of America;2. Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, United States of America;3. Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, United States of America;4. Brigham and Women''s Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, MA, United States of America;5. Valley Anesthesiology and Pain Consultants, Envision Physician Services, Phoenix, AZ, United States of America;6. Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, United States of America;1. New York-Presbyterian Hospital - Weill Cornell, Department of Anesthesiology, 525 E 68th St, New York, NY 10065, United States;2. Weill Cornell Medicine, Department of Anesthesiology, 525 E 68th St, New York, NY 10065, United States;1. Department of Anesthesiology and Perioperative Medicine, Queen''s University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada;2. Kingston General Hospital Research Institute, Kingston Health Sciences Centre, Kingston, Ontario K7L 2V7, Canada;3. Department of Public Health Sciences, Queen''s University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada;4. Department of Anesthesiology, São Luiz Hospital - ITAIM / Rede D''Or – CMA Anestesia team, São Paulo, SP, Brazil;1. Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, 300 West Drake Street, Colorado State University, Fort Collins, CO 80523, United States;2. Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 451 Newton Road, 200 Medicine Administration Building, Iowa City, IA 52242, United States |
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| Abstract: | Study objectiveAlthough combined thoracic paravertebral blockade (TPVB)-general anesthesia (GA) could improve pain control compared to GA alone after thoracoscopic lung cancer surgery, it has not been established whether this improvement in pain control could reduce associated adverse outcomes. Thus, this study aimed to explore the association between TPVB usage and adverse outcomes after thoracoscopic lung cancer surgery.DesignRetrospective cohort study from a prospective database.SettingA high-volume thoracic center in China.Patients13966 consecutive patients who received thoracoscopic lung cancer surgery from January 2016 to December 2018 in Shanghai Chest Hospital were enrolled.MeasurementsWith a 1:1 propensity score matching (PSM) analysis, adverse outcomes between GA alone and GA-TPVB were investigated. Multivariate and multiple linear regression analysis were used to identify factors and calculate odds radio (OR) for adverse outcomes.ResultsThe rate of TPVB usage was 14.8% (2070 out of 13,966). TPVB combined with GA was associated with lower rates of postoperative pulmonary complications (PPCs) (30.4% vs 33.5%, P = 0.005) and postoperative atrial fibrillation (POAF) (2.1% vs 2.9%, P = 0.041), and shorter length of hospital stay (LOS) (Median IQR]; 54-5] vs 54-6]) days, P < 0.001) compared to GA alone. After a 1:1 PSM analysis, we investigated adverse outcomes in 2640 (1320 pairs) patients with or without TPVB usage, and this association remained existed, namely, the rates of PPCs (29.8% vs 34.2%, P = 0.014) and POAF (2.2% vs 3.6%, P = 0.028) were lower and LOS was shorter (54-5] vs 54-6] days, P < 0.001) in the GA-TPVB group. In multivariate analysis, the combination of GA plus TPVB was independent predictor for PPCs (OR = 0.879, 95%CI, 0.793–0.974, P = 0.014) and POAF (OR = 0.714, 95%CI, 0.516–0.988, P = 0.042), respectively. However, in multiple linear analysis, lower rates of PPCs and POAF associated with TPVB usage, rather than TPVB usage, were responsible for the reduced LOS.ConclusionsThe usage of TPVB may be a feasible and adjustable approach to reduce the rates of PPCs and POAF and associated LOS in thoracoscopic lung cancer surgery. |
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