Imagine your brain is like a labyrinth, constantly navigating through twists and turns. Just as a guiding light can help you find your way in a complex maze, a paravertebral block (PVB) can reduce the risk of getting lost in the fog of postoperative neurocognitive disorder (POD). In a recent systematic review and meta-analysis of randomized controlled trials, it was found that PVB significantly reduces the incidence of POD and delayed neurocognitive recovery (DNR) in adult patients undergoing major surgery with general anesthesia. This means that PVB can act as a beacon, guiding patients towards clear thinking and improved cognitive function after surgery. The analysis also revealed other benefits of PVB, such as reduced pain scores and opioid use, lower blood pressure during and after surgery, and shorter hospital stays. While these findings are promising, further research with larger sample sizes is needed to confirm the effectiveness of PVB in preventing perioperative neurocognitive disorder. So, if you or a loved one might be facing major surgery, why not explore the potential benefits of PVB? It could be the guiding light that leads to a smoother recovery.

ObjectiveTo investigate whether paravertebral block reduces postoperative delirium (POD)/delayed neurocognitive recovery (DNR) in adults after major surgery with general anesthesia.MethodsFor this systematic review and meta-analysis, we searched online databases PubMed, EMBASE, CENTRAL, and Web of Science till March 19th, 2023 to examine studies which use paravertebral block (PVB) for perioperative neurocognitive disorder. Primary and secondary outcomes were identified for the incidence of perioperative neurocognitive disorder. We did not restrict the follow-up duration of the included studies. Statistical analysis was performed to calculate mean difference (MD), Odd ratios (OR) and CI between RCTs. The quality of the evidence was assessed with the Cochrane risk of bias tool. The registration number of the study in PROSPERO is CRD42023409502. PROSPERO is an international database of prospectively registered systematic reviews. Registration provides transparency in the review process and it helps counter publication bias.ResultsTotal 1,225 patients from 9 RCTs were analyzed. The incidence of POD [Odds Ratio (OR) = 0.48, 95% CI 0.32, 0.72; p = 0.0004; I2 = 0%] and DNR [OR = 0.32, 95% CI 0.13, 0.80; p = 0.01; I2 = 0%] were significantly reduced in PVB group. The analysis showed no significant differences in postoperative MMSE scores [MD = 0.50, 95% CI −2.14, 3.15; p = 0.71; I2 = 98%]. Paravertebral block analgesia reduces pain scores and/or opioid use after surgery. Additionally, blood pressure was significantly lower in the PVB group, intraoperatively [MD = −15.50, 95% CI −20.71, −10.28; p < 0.001; I2 = 12%] and postoperatively [MD = −5.34, 95% CI −10.65, −0.03 p = 0.05; I2 = 36%]. Finally, PVB group had significantly shorter hospital stays [MD = −0.86, 95% CI −1.13, −0.59; p < 0.001; I2 = 0%].ConclusionParavertebral block analgesia may prevent perioperative POD/DNR in patients undergoing major surgery. Further research with large sample sizes is required to confirm its effectiveness.

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