Impact of thoracic paravertebral block and sufentanil on outcomes and postoperative cognitive dysfunction in thoracoscopic lung cancer surgery

Effects of sufentanil on immune response, pain mediators and brain-sparing effect in patients with breast cancer undergoing radical mastectomy

OBJECTIVE

To investigate the effects of sufentanil on immune response, pain mediators and brain-sparing effect in patients with breast cancer undergoing radical mastectomy.

METHODS

This study was a single center retrospective cohort study. The 118 study subjects were diagnosed and treated in our hospital from the period of January 2020-October 2022, who planned to undergo radical surgery for breast cancer. According to the different surgical drugs, these subjects were divided into sufentanil group and the control group, with 59 cases each. The visual analog scores (VAS) of patients in two groups were compared at 24 hour and 48 hour after surgery. The immune response indexes (including CD3+, CD4+, CD8+, CD4+/CD8+), pain mediators (β-endorphin, substance P and 5-hydroxytryptophan), brain-sparing effect indexes [arterio-venous oxygen content difference (Da-jvO2), jugular bulb venous saturation (S-jvO2), cerebral oxygen uptake (CEO2) and the Mini Mental State Scale (MMSE)], and brain damage indexes [S100 calcium-binding protein B (S100B) and neuron-specific enolase (NSE)] in two groups were compared. The incidence of adverse reactions in two groups was compared.

RESULTS

VAS scores were obviously lower in the sufentanil group than the control group at 24 hour and 48 hour postoperatively (P<0.001). Compared with the control group, the sufentanil group had higher CD3+, CD4+, CD4+/CD8+, MMSE scores, and lower content of CD8+, β-Endorphins, substance P, 5-hydroxytryptophan, Da-jvO2, S-jvO2 and CEO2 at 24 hour and 48 hour postoperatively (P<0.05). Patients in the sufentanil group had lower levels of S100B and NSE than the control group on the 1st and 7th day after surgery (P<0.01). The incidence of gastrointestinal reactions, hypertension and chills was significantly lower in the sufentanil group than the control group (P<0.05).

CONCLUSION

The application of sufentanil in breast cancer radical surgery effectively improved the immune function of the body, reduced pain response, alleviated brain damage, and had a certain brain-sparing effect.

Current perspectives on postoperative cognitive dysfunction in geriatric patients: insights from clinical practice

Postoperative cognitive dysfunction (POCD) is a common and serious postoperative complication in elderly patients, affecting cognitive function and quality of life. Its pathophysiology is complex, involving age-related cognitive decline, surgical and anesthetic factors, systemic and neuroinflammation, as well as genetic and environmental contributors. Comprehensive preoperative assessment and optimization, the selection of appropriate anesthetic agents, minimally invasive surgical techniques, and early postoperative rehabilitation and cognitive training are effective strategies to reduce the incidence of POCD. Recent research suggests that anti-inflammatory drugs and neuroprotective agents may be promising in preventing POCD. Additionally, non-pharmacological interventions, including cognitive and physical training, have shown positive effects. Future research directions should include large-scale clinical trials and mechanistic studies to further understand and manage POCD, along with integrating new findings into clinical practice. Continuous education and training for healthcare professionals are essential to ensure the effective application of the latest research findings in patient care. Through multidisciplinary collaboration and ongoing improvements, these efforts can significantly enhance the cognitive function and quality of life of elderly surgical patients.