Effects of flurbiprofen combined with quadratus lumborum block on postoperative neurocognitive function and inflammatory response in elderly patients with nephrectomy under general anesthesia
AIM To evaluate the effects of flurbiprofen combined with quadratus lumborum block(QLB)on postoperative neurocognitive function and inflammatory response in elderly patients undergoing nephrectomy.METHODS Sixty elderly patients undergoing laparoscopic nephrectomy were randomized into group Q(QLB group)and group FQ(flurbiprofen combined with QLB group),30 patients in each group.Ultrasound guided anterior QLB were performed in all patients on the surgical side.Patients in group FQ received flurbiprofen 1 mg·kg-1 iv 10 min before surgery.Then both groups received general anesthesia.The dosages of propofol and remifentanil during surgery and the effective number of analgesia pump presses were recorded.The scores of visual analogue scale(VAS)and Bruggrmann comfort scale(BCS)were evaluated at 6,24,48 h after surgery.The neurocognitive function was evaluated at 1 d before surgery and 1 d and 7 d after surgery using the mini-mental state examination(MMSE),and the incidence of postoperative neurocognitive disorder(PND)within 7 d after surgery was recorded.Venous blood was collected and the serum levels of high mobility group box protein 1(HMGB1)and interleukin 6(IL-6)were tested 1 h before surgery and 30 min and 24 h after the surgery.RESULTS Compared with group Q,the dosage of remifentanil was significantly reduced in group FQ(P＜0.05),and the effective numbers of analgesia pump presses were reduced in group FQ(P＜0.05).At 6,24 h after surgery,the VAS score was lower,and the BCS score was higher in group FQ than group Q(P＜0.05).Compared with group Q,the MMSE score at 1,7 d after surgery was significantly higher in the group FQ(P＜0.05),the incidence of PND within 7 d after surgery was lower in group FQ(P＜0.05).The HMGB1 and IL-6 levels at 30 min,24 h after the surgery were significantly lower in group FQ than group Q(P＜0.05).CONCLUSION Flurbiprofen combined with QLB can reduce the incidence of PND in elderly patients undergoing nephrectomy,which may be related to the perfect early postoperative analgesia and the decreased levels of inflammatory cytokines.
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