Association Between Intercostal Nerve Block and Postoperative Glycemic Control in Patients with Diabetes Undergoing Video-assisted Thoracoscopic Pulmonary Resection: A Retrospective Study

Abstract Objectives We sought to investigate association between intercostal nerve block (INB) and postoperative glycemic control in patients with diabetes undergoing video-assisted thoracoscopic pulmonary resection. Design A retrospective study. Setting Single-center tertiary academic hospital. Participants Patients with diabetes, aged 18-79 years, who had undergone elective video-assisted thoracoscopic pulmonary resection (segmentectomy or lobectomy) from January 1, 2015 to December 31, 2018. Interventions Postoperative blood glucose levels and insulin dosage were extracted from the record. Measurements and Main Results The patients with diabetes who received INB before closure of surgical incisions were compared to those who did not receive INB. The primary outcome was the daily blood glucose (BG) level. Univariate analyses and multivariate regression analysis were performed to explore risk factors of hyperglycemia within 48 h after the surgery. Baseline characteristics were comparable between the two groups. Patients who received INB had lower maximum BG level and amplitude of glycemic excursion from 0-24 h after the surgery (P = 0.007, P = 0.041, respectively) and lower maximum and minimum BG levels from 24-48 h after the surgery (P = 0.023, P = 0.006, respectively). Meanwhile, the daily insulin dose increment during 0-24 h and 24-48 h after the surgery decreased (P = 0.010, P = 0.003, respectively), white blood cell count within 48 h after the surgery were lower (P = 0.021), and length of postoperative stay decreased in the INB group (P = 0.044). Multivariate regression analysis further confirmed that INB was an independent protective factor of postoperative hyperglycemia (Method, enter; Nagelkerke R2 value, 0.229; odds ratio, 0.298; 95% confidence interval, 0.099-0.901; P = 0.032). Conclusion INB, performed before closure of surgical incisions, was associated with improved glycemic control in patients with diabetes within 48 h after video-assisted thoracoscopic pulmonary resection.