The use of peripheral nerve block decrease incidence of postoperative cognitive dysfunction following orthopedic surgery: A systematic review and meta-analysis

作者：Liyun Deng, Bo Jiao, Jingjing Cai, Xiaolin Xu, Ming‐Yuan Chen, Caiyi Yan, Tao Zhu, Jin Liu, Daqing Ma, Chan Chen · 发表于：BMC Anesthesiology · 年份：2024 · DOI：10.1186/s12871-024-02743-y · 被引用次数：6 · 研究领域：Intensive Care Unit Cognitive Disorders、Anesthesia and Neurotoxicity Research、Anesthesia and Sedative Agents

Postoperative neurocognitive disorders (PNDs) frequently occur following orthopedic surgery and are closely associated with adverse prognosis. PNDs are an emerging concept that includes both postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). The prevention of combined use of peripheral nerve block (PNB) and general anesthesia (GA) on POCD and/or POD incidence following orthopedic surgery remains unknown. We aimed to investigate the effect of this combined anesthesia method on POCD/POD incidence after orthopedic surgery, compared with GA. The databases of PubMed, Web of Science, Embase via Ovid, and the Cochrane Central Register of Controlled Trials were searched for all available randomized controlled trials (RCTs). The incidence of POD/POCD was the primary outcome. Continuous and dichotomous outcomes are represented as standardized mean differences [SMD, 95% confidence interval (CI)] and risk ratios [RR, 95%CI], respectively. Meta-analysis of twelve RCTs with a total of 1488 patients revealed that compared with GA, PNB plus GA decreased the incidence of POCD (RR: 0.58, 95%CI: 0.35 to 0.95, P = 0.03, I 2 = 0%), while the incidence of POD had no significant difference (RR: 0.87, 95%CI: 0.54 to 1.40, P = 0.57, I 2 = 67%). Compared with GA alone, a significant decrease of intraoperative and postoperative opioid consumption (SMD: -1.54, 95%CI: -2.26 to -0.82, P < 0.0001, I 2 = 89%; SMD: -7.00, 95%CI: -9.89 to -4.11, P < 0.00001, I 2 = 99%) and postoperat...