{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:56:14Z","timestamp":1791899774716,"version":"4.3.4"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Surgery remains the mainstay treatment for older patients with lung cancer, and paravertebral block (PVB) is recommended for perioperative analgesia. With the increasing surgical demand, a growing proportion of elective thoracic procedures in China are scheduled at night. Circadian variation, prolonged fasting, and resource limitations may affect intraoperative hemodynamics. However, the comparative hemodynamic safety of daytime versus nighttime PVB has not been systematically investigated. We emulated a target trial using routinely collected anesthesia and electronic medical records from the Cancer Hospital Chinese Academy of Medical Sciences (Oct-2020 to Jun-2022). Patients aged \u226565\u202fyears undergoing lung cancer surgery with PVB were classified into daytime (08:00\u201316:59) or nighttime (17:00\u20137:59) groups. Confounding was addressed with stabilized inverse probability of treatment weighting. The primary outcomes were intraoperative hypotension (systolic blood pressure &amp;lt;90\u202fmmHg or diastolic blood pressure &amp;lt;60\u202fmmHg) and bradycardia (heart rate &amp;lt;60\u202fbpm). Secondary outcomes included intravenous fluid volume and vasoactive drug use. Time-to-first and recurrent events were assessed using weighted Cox and Poisson regression. Sensitivity analyses included propensity score matching, restricting to patients with PVB after general anesthesia, and adding surgical type as a covariate. Among 637 patients (479 daytime, 158 nighttime), nighttime PVB was associated with more recurrent hypotension (adjusted-incidence rate ratio [IRR]: 1.04; 95% confidence interval [CI], 1.01\u20131.09), but no difference in bradycardia (hazard ratio [HR]: 1.11, 95% CI, 0.90\u20131.36; IRR 1.02, 95%CI 0.98\u20131.05). Intravenous fluid use was lower at night (mean difference \u221253.20\u202fmL; 95% CI, \u2212104.36 to \u22122.04). Findings were robust across sensitivity analyses, with stronger associations in women and patients with hypertension or arrhythmia. We conclude that in older patients undergoing lung cancer surgery, nighttime PVB was linked to a modestly higher burden of hypotension and lower fluid administration compared with daytime PVB. Vigilant monitoring and optimized perioperative management are warranted, and multicenter studies should validate these findings.<\/jats:p>","DOI":"10.3389\/fmed.2026.1752499","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T05:47:48Z","timestamp":1787118468000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative effectiveness of daytime versus nighttime paravertebral block analgesia on intraoperative hemodynamics in older lung cancer patients: a target trial emulation study"],"prefix":"10.3389","volume":"13","author":[{"given":"Qiang","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Zhuo","sequence":"additional","affiliation":[{"name":"Research Center of Clinical Epidemiology, Peking University Third Hospital","place":["Beijing, China"]},{"name":"Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bowen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaibing","family":"Yang","sequence":"additional","affiliation":[{"name":"Information Management Center, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shijing","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingchao","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinwei","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolin","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center","place":["Beijing, China"]},{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet","place":["Stockholm, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.1001\/jamaoncol.2019.2996","article-title":"Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the global burden of disease study","volume":"5","author":"Fitzmaurice","year":"2019","journal-title":"JAMA Oncol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1093\/ejcts\/ezy301","article-title":"Guidelines for enhanced recovery after lung surgery: recommendations of the enhanced recovery after surgery (eras\u00ae) society and the European Society of Thoracic Surgeons (ESTS)","volume":"55","author":"Batchelor","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1111\/anae.15609","article-title":"Prospect guidelines for video-assisted thoracoscopic surgery: a systematic review and procedure-specific postoperative pain management recommendations","volume":"77","author":"Feray","year":"2022","journal-title":"Anaesthesia"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.suronc.2020.03.006","article-title":"Analgesic and opioid-sparing effects of single-shot preoperative paravertebral block for radical mastectomy with immediate reconstruction: a retrospective study with propensity-adjusted analysis","volume":"34","author":"Gayraud","year":"2020","journal-title":"Surg Oncol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1186\/s12885-021-08938-7","article-title":"Comparison of the analgesic effect of ultrasound-guided paravertebral block and ultrasound-guided retrolaminar block in uniportal video-assisted thoracoscopic surgery: a prospective, randomized study","volume":"21","author":"Wang","year":"2021","journal-title":"BMC Cancer"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1186\/s12957-020-02071-8","article-title":"Effect of thoracic paravertebral nerve block on the early postoperative rehabilitation in patients undergoing thoracoscopic radical lung Cancer surgery","volume":"18","author":"Kang","year":"2020","journal-title":"World J Surg Oncol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/j.bja.2018.10.063","article-title":"Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications","volume":"122","author":"Cortegiani","year":"2019","journal-title":"Br J Anaesth"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1097\/TA.0b013e3181e49291","article-title":"What is the safety of nonemergent operative procedures performed at night? A study of 10,426 operations at an academic tertiary care hospital using the American College of Surgeons National Surgical Quality Program Improvement Database","volume":"69","author":"Turrentine","year":"2010","journal-title":"J Trauma"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/978-3-319-24223-1_1","article-title":"Lung cancer statistics","volume":"893","author":"Torre","year":"2016","journal-title":"Adv Exp Med Biol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1186\/s12913-020-05126-4","article-title":"Influence of trends in hospital volume over time on patient outcomes for high-risk surgery","volume":"20","author":"Payet","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1038\/s41569-019-0167-4","article-title":"Circadian rhythms and the molecular clock in cardiovascular biology and disease","volume":"16","author":"Crnko","year":"2019","journal-title":"Nat Rev Cardiol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1016\/s0828-282x(07)70733-x","article-title":"Night-time blood pressure patterns and target organ damage: a review","volume":"23","author":"Routledge","year":"2007","journal-title":"Can J Cardiol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1016\/s0140-6736(12)62167-9","article-title":"Frailty in elderly people","volume":"381","author":"Clegg","year":"2013","journal-title":"Lancet (London, England)"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1007\/s10741-011-9270-2","article-title":"Age-associated changes in cardiovascular structure and function: a fertile milieu for future disease","volume":"17","author":"Fleg","year":"2012","journal-title":"Heart Fail Rev"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1196\/annals.1395.038","article-title":"Vascular smooth muscle and endothelial functions in aging","volume":"1100","author":"Yildiz","year":"2007","journal-title":"Ann N Y Acad Sci"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1053\/j.jvca.2017.10.003","article-title":"Paravertebral block for thoracic surgery","volume":"32","author":"D'Ercole","year":"2018","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1093\/aje\/kwv254","article-title":"Using big data to emulate a target trial when a randomized trial is not available","volume":"183","author":"Hern\u00e1n","year":"2016","journal-title":"Am J Epidemiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"402","DOI":"10.7326\/annals-24-01871","article-title":"The target trial framework for causal inference from observational data: Why and when is it helpful?","volume":"178","author":"Hern\u00e1n","year":"2025","journal-title":"Ann Intern Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1629","DOI":"10.1093\/ndt\/gfy283","article-title":"Merits and caveats of propensity scores to adjust for confounding","volume":"34","author":"Fu","year":"2019","journal-title":"Nephrol Dial Transplant"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1093\/ckj\/sfab158","article-title":"An introduction to inverse probability of treatment weighting in observational research","volume":"15","author":"Chesnaye","year":"2022","journal-title":"Clin Kidney J"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1093\/aje\/kwad031","article-title":"Inverse probability weighting to estimate exposure effects on the burden of recurrent outcomes in the presence of competing events","volume":"192","author":"Gaber","year":"2023","journal-title":"Am J Epidemiol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1007\/s10916-022-01802-6","article-title":"Consecutive surgeon and Anesthesia team improve turnover time in the operating room","volume":"46","author":"Sarpong","year":"2022","journal-title":"J Med Syst"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"7561","DOI":"10.1038\/s41598-025-88558-4","article-title":"The impact of the hierarchical medical system on medical resource allocation in China","volume":"15","author":"Fu","year":"2025","journal-title":"Sci Rep"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"171","DOI":"10.3390\/healthcare12020171","article-title":"Interventions for compassion fatigue in healthcare providers-a systematic review of randomised controlled trials","volume":"12","author":"Patole","year":"2024","journal-title":"Healthcare (Basel)"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1034\/j.1399-6576.2002.460906.x","article-title":"Compensatory fluid administration for preoperative dehydration\u2014Does it improve outcome?","volume":"46","author":"Holte","year":"2002","journal-title":"Acta Anaesthesiol Scand"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1572","DOI":"10.1097\/00000539-200212000-00018","article-title":"Duration of preoperative fast correlates with arterial blood pressure response to halothane in infants","volume":"95","author":"Friesen","year":"2002","journal-title":"Anesth Analg"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/j.bja.2023.08.026","article-title":"Intraoperative hypotension and postoperative outcomes: a meta-analysis of randomised trials","volume":"131","author":"D'Amico","year":"2023","journal-title":"Br J Anaesth"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1629","DOI":"10.3109\/07420528.2010.510230","article-title":"Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study","volume":"27","author":"Hermida","year":"2010","journal-title":"Chronobiol Int"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1007\/s10552-005-9015-4","article-title":"Biological clocks and shift work: circadian dysregulation and potential long-term effects","volume":"17","author":"Haus","year":"2006","journal-title":"Cancer Causes Control"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"3190","DOI":"10.1111\/bph.14116","article-title":"New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation","volume":"175","author":"Zisapel","year":"2018","journal-title":"Br J Pharmacol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"577","DOI":"10.2147\/vhrm.S24603","article-title":"Effect of melatonin on nocturnal blood pressure: meta-analysis of randomized controlled trials","volume":"7","author":"Grossman","year":"2011","journal-title":"Vasc Health Risk Manag"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.neubiorev.2009.12.011","article-title":"The cortisol awakening response: more than a measure of HPA axis function","volume":"35","author":"Clow","year":"2010","journal-title":"Neurosci Biobehav Rev"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1038\/nrn2914","article-title":"The crucial role of pulsatile activity of the HPA axis for continuous dynamic equilibration","volume":"11","author":"Lightman","year":"2010","journal-title":"Nat Rev Neurosci"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"16464","DOI":"10.1038\/s41598-022-20870-9","article-title":"The influence of preoperative anxiety on postoperative pain in patients undergoing cardiac surgery","volume":"12","author":"Fern\u00e1ndez-Castro","year":"2022","journal-title":"Sci Rep"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1093\/bja\/aes313","article-title":"Influence of preoperative anxiety on hypotension after spinal anaesthesia in women undergoing caesarean delivery","volume":"109","author":"Orbach-Zinger","year":"2012","journal-title":"Br J Anaesth"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1097\/00004872-200302000-00031","article-title":"Acute effects of transdermal estrogen on hemodynamic and vascular reactivity in elderly postmenopausal healthy women","volume":"21","author":"Manhem","year":"2003","journal-title":"J Hypertens"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"5523516","DOI":"10.1155\/2021\/5523516","article-title":"Protective effects of Estrogen on cardiovascular disease mediated by oxidative stress","volume":"2021","author":"Xiang","year":"2021","journal-title":"Oxidative Med Cell Longev"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1038\/s41371-022-00771-0","article-title":"Estrogen-mediated mechanisms in hypertension and other cardiovascular diseases","volume":"37","author":"Visniauskas","year":"2023","journal-title":"J Hum Hypertens"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"136","DOI":"10.3390\/jcdd9050136","article-title":"Mechanisms and clinical implications of endothelial dysfunction in arterial hypertension","volume":"9","author":"Ambrosino","year":"2022","journal-title":"J Cardiovasc Dev Dis"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.3390\/medicina57121288","article-title":"Polypharmacy in the management of arterial hypertension-friend or foe?","volume":"57","author":"Diaconu","year":"2021","journal-title":"Medicina (Kaunas)"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1097\/hjh.0000000000003344","article-title":"Intravenous antihypertensive drugs: A double-edged sword?","volume":"41","author":"van Twist","year":"2023","journal-title":"J Hypertens"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1152\/japplphysiol.01356.2009","article-title":"Effect of blood pressure on vascular hemodynamics in acute tachycardia","volume":"109","author":"Zheng","year":"2010","journal-title":"J Appl Physiol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"857","DOI":"10.5603\/CJ.a2019.0021","article-title":"Tachycardia: the hidden cardiovascular risk factor in uncomplicated arterial hypertension","volume":"27","author":"Cierpka-Kmie\u0107","year":"2020","journal-title":"Cardiol J"}],"updated-by":[{"DOI":"10.3389\/fmed.2026.2004550","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000}}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1752499\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:35:02Z","timestamp":1791898502000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1752499\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,19]]},"references-count":44,"alternative-id":["10.3389\/fmed.2026.1752499"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1752499","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,19]]},"article-number":"1752499"}}