RESUMEN
BACKGROUND: Delirium is a common postoperative complication in older patients undergoing thoracic surgery and presages poor outcomes. Postoperative pain is an important factor in the progression of delirium. The purpose of this study was to test whether continuous thoracic paravertebral block (PVB), a more effective approach for analgesia, could decrease the incidence of delirium in elderly patients undergoing esophagectomy. METHODS: A total of 180 geriatric patients undergoing esophagectomy were randomly divided into 2 groups and treated with PVB or patient-controlled analgesia (PCA). Perioperative plasma CRP, IL-1ß, IL-6, and TNF-α levels were detected in all patients. Pain intensity was measured by a numerical rating scale. Delirium was assessed using the confusion assessment method. RESULTS: The incidence of postoperative delirium was significantly lower in the PVB group than in the PCA group. Patients in the PVB group had lower plasma CRP, IL-1ß, IL-6, and TNF-α levels and less pain when coughing after surgery. CONCLUSIONS: Ultrasound-guided continuous thoracic paravertebral block improved analgesia, reduced the inflammatory reaction and decreased the occurrence of delirium after surgery.
Asunto(s)
Delirio/prevención & control , Esofagectomía/normas , Bloqueo Nervioso/métodos , Ultrasonografía/normas , Anciano , Anciano de 80 o más Años , Analgesia Controlada por el Paciente/métodos , Analgesia Controlada por el Paciente/normas , Delirio/tratamiento farmacológico , Esofagectomía/métodos , Femenino , Geriatría/métodos , Humanos , Masculino , Persona de Mediana Edad , Bloqueo Nervioso/normas , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Ultrasonografía/métodos , Ultrasonografía/estadística & datos numéricosRESUMEN
Objective To explore the influence of obesity in surgical site infection (SSI) following spine surgery.Methods Literatures on relationship between obesity and spine surgery were collected. Data were extracted, checked, and analyzed with STATA 11.0 software by two researchers independently, fixed-effect model and random-effect model were used to analyze the combined OR value and its 95％ confidence interval (95％CI). Results A total of 32 literatures involving 110 877 patients were included in the study. Most studies were thoracic or lumbar surgery. SSI rate in obesity group was higher than control group (OR, 2.56 [95％CI, 1.95-3.36]). Stratified analysis result showed that incidence of infection in obese Caucasians was 2.50 times higher than that in control group (95％CI, 1.77-3.52), obese people in Asia was 2.77 times higher than that of people with normal weight (95％CI, 1.81-4.22).Conclusion Among Caucasians and Asians, obese people are more likely to have SSI following spine surgery.