Background and Aims The effect of peripheral nerve block (PNB) under general anesthesia (GA) on the clinical outcome comparing GA alone remains unknown. We hypothesized that PNB is associated with reduced postoperative delirium and improved patients morbidity after surgical procedures.
Methods We used a nationwide inpatient database in Japan to compare patient outcomes by GA with PNB versus GA alone from April 2016 to October 2019. Our primary outcome was postoperative delirium. The incidence of morbidity were secondary outcomes. We conducted propensity score matched analyses of patients who underwent all surgical procedures using 41 covariates. Chi-square analyses were performed to calculate odds ratios and their 95% confidence intervals (CI). For sensitivity analyses, we performed instrumental variables and restricted the definition of postoperative delirium and subgroup.
Results Of 591,578 patients, 82,461 received GA-PNB, and 509,117 received GA group. After one to four propensity score matching, 81,873 patients were included in the GA-PNB group and 204,932 in the GA group. The adjusted odds ratios for postoperative delirium, composite morbidity were 0.953 (95%CI 0.924 to 0.982), 0.766 (95%CI 0.727 to 0.806), respectively, for the GA-PNB group with reference to the GA group. For sensitivity analyses, findings were also consistent with instrumental variable and subgroup analyses.
Conclusions This retrospective, nationwide cohort study demonstrated that PNB underwent GA was associated with reduced postoperative delirium and composite morbidity.
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