TY - JOUR
T1 - Role of supplemental regional blocks on postoperative neurocognitive dysfunction after major non-cardiac surgeries
T2 - A systematic review and meta-analysis of randomized controlled trials
AU - Singh, Narinder P.
AU - Makkar, Jeetinder Kaur
AU - Borle, Anuradha
AU - Singh, Preet Mohinder
N1 - Publisher Copyright:
© 2024 American Society of Regional Anesthesia & Pain Medicine. Published by BMJ.
PY - 2022/12/19
Y1 - 2022/12/19
N2 - Background/importance Postoperative neurocognitive dysfunction (PNCD) is a frequent and preventable complication after surgery. The large high-quality evidence for the efficacy of supplemental regional analgesia blocks (RAB) for preventing PNCD is still elusive. Objective The objective of this meta-analysis was to evaluate the effect of RAB versus standard anesthesia care on the incidence of PNCD in adult patients undergoing major non-cardiac surgery. Evidence review PubMed, EMBASE, Scopus, and the Cochrane Central Registers of Controlled Trials (CENTRAL) were searched for randomized controlled trials (RCTs) from 2017 until June 2022. The primary outcome was the incidence of PNCD within 1 month of surgery. A random-effects model with an inverse variance method was used to pool results, and OR and mean differences were calculated for dichotomous and continuous outcomes. Various exploratory subgroup analyses were performed to explore the possibility of the association between the various patient, technique, and surgery-related factors. Grading of Recommendation, Assessment, Development, and Evaluation guidelines were used to determine the certainty of evidence. Findings Twenty-six RCTs comprizing 4414 patients were included. The RAB group was associated with a significant reduction in the incidence of PNCD with an OR of 0.46 (95% CI 0.35 to 0.59; p<0.00001; I 2 =28%) compared with the control group (moderate certainty). Subgroup analysis exhibited that the prophylactic efficacy of RAB persisted for both delirium and delayed neurocognitive recovery. Conclusions Current evidence suggests that supplemental RAB are beneficial in preventing PNCD in patients after major non-cardiac surgery.
AB - Background/importance Postoperative neurocognitive dysfunction (PNCD) is a frequent and preventable complication after surgery. The large high-quality evidence for the efficacy of supplemental regional analgesia blocks (RAB) for preventing PNCD is still elusive. Objective The objective of this meta-analysis was to evaluate the effect of RAB versus standard anesthesia care on the incidence of PNCD in adult patients undergoing major non-cardiac surgery. Evidence review PubMed, EMBASE, Scopus, and the Cochrane Central Registers of Controlled Trials (CENTRAL) were searched for randomized controlled trials (RCTs) from 2017 until June 2022. The primary outcome was the incidence of PNCD within 1 month of surgery. A random-effects model with an inverse variance method was used to pool results, and OR and mean differences were calculated for dichotomous and continuous outcomes. Various exploratory subgroup analyses were performed to explore the possibility of the association between the various patient, technique, and surgery-related factors. Grading of Recommendation, Assessment, Development, and Evaluation guidelines were used to determine the certainty of evidence. Findings Twenty-six RCTs comprizing 4414 patients were included. The RAB group was associated with a significant reduction in the incidence of PNCD with an OR of 0.46 (95% CI 0.35 to 0.59; p<0.00001; I 2 =28%) compared with the control group (moderate certainty). Subgroup analysis exhibited that the prophylactic efficacy of RAB persisted for both delirium and delayed neurocognitive recovery. Conclusions Current evidence suggests that supplemental RAB are beneficial in preventing PNCD in patients after major non-cardiac surgery.
KW - Outcome Assessment, Health Care
KW - Pain, Postoperative
KW - Treatment Outcome
KW - analgesia
UR - http://www.scopus.com/inward/record.url?scp=85148667901&partnerID=8YFLogxK
U2 - 10.1136/rapm-2022-104095
DO - 10.1136/rapm-2022-104095
M3 - Review article
C2 - 36535728
AN - SCOPUS:85148667901
SN - 1098-7339
VL - 49
SP - 49
EP - 58
JO - Regional Anesthesia and Pain Medicine
JF - Regional Anesthesia and Pain Medicine
IS - 1
ER -