Hypnotic drug use and intraoperative fluid balance associated with postoperative delirium following pancreatic surgery: A retrospective, observational, single-center study

by Zhi-Hua Huang, Jun Zhang, Xiao-ying Xu, Ying Wang, Xiao-jian Lu, Yan Luo

Background

Postoperative delirium is a common complication after various types of major surgery. The aim of this study was to identify risk factors associated with delirium following pancreatic surgery.

Methods

Data from the patients who had pancreatic surgery between July 2020 and March 2021 in Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine were retrospectively analysed. The postoperative risk factors related to delirium were analyzed by univariate and multivariate Logistic regression analysis.

Results

59 of 385 patients (15.3%) developed postoperative delirium after pancreatic surgery. The ROC curve revealed the optimal cutoff of intraoperative fluid balance was 2863ml. Furthermore, the multivariate analysis demonstrated that age ≥  65 years old [Odds ratio (OR) 2.01; 95% Confidence interval (CI) 1.12-3.63; p =  0.019], hypnotic drug use (OR 4.17; 95% CI 1.50-11.10; p =  0.005), and intraoperative fluid balance (OR 2.57; 95% CI 1.37-4.84; p =  0.003) were the independent risk factors of postoperative delirium.

Conclusion

This study identified that intraoperative fluid balance and hypnotic drug use were independent risk factors associated with postoperative delirium development after pancreatic surgery.

The impact of paravertebral nerve blockade on postoperative surgical site wound pain management in patients undergoing video‐assisted thoracoscopic surgery for pulmonary carcinoma resection

Abstract

Management of postoperative pain is of vital importance for patients undergoing Video-Assisted Thoracoscopic Surgery (VATS) for Pulmonary Carcinoma Resection. The study evaluates the impact of Paravertebral Nerve Blockade (PNB) in conjunction with general anaesthesia on postoperative pain relief, as compared with general anaesthesia alone. A retrospective analysis was carried out from May 2020 to May 2023, involving 100 patients with pathologically confirmed pulmonary carcinoma. The patients were divided into two groups: a control group that received general anaesthesia and an observation group that received a combination of general anaesthesia and PNB. The intensity of postoperative pain was assessed at various time intervals using the visual analogue scale (VAS), while the effectiveness of patient-controlled analgesia was also evaluated. Additionally, the study examined the incidence rates of chronic pain in the postoperative period. Statistical analysis was performed using IBM SPSS version 27.0. Significant reductions in VAS scores for both resting and cough-induced pain were observed in the observation group at 2 and 6 h post-operation (p < 0.01). However, the difference diminished over time. The observation group had fewer patient-controlled analgesia activations and required lower dosages of hydromorphone at both 24- and 48-h post-operation. The incidence of chronic pain was also significantly lower in the observation group (24.00%) compared with the control group (54.00%) (p < 0.01). PNB, when administered in combination with general anaesthesia, significantly reduces immediate postoperative pain and the requirement for additional analgesics in patients undergoing VATS for pulmonary carcinoma resection. The effect diminishes over time but has a lasting impact on reducing the incidence of chronic postoperative pain.