Effects of different analgesia regimens on early post‑operative cognitive dysfunction in elderly patients undergoing radical resection of cervical carcinoma

Abstract

This study was designed to compare the effects of epidural and intravenous analgesia on early post-operative cognitive dysfunction (POCD) in elderly patients undergoing radical resection of cervical cancer. For this purpose, 74 patients aged 60-78 years [body mass index (BMI), 18-25 kg/m 2 ; American Society of Anesthesiologists (ASA) classification score of I-III) undergoing radical resection of cervical cancer were divided into the epidural group (group E) and parenteral group (group P) groups (37 patients in each group). All patients underwent their surgical procedures under epidural anesthesia and intravenously-delivered general anesthesia. Patient-controlled analgesia (PCA) was supplied for 72 h after the surgery. Epidural analgesia was provided for the patients in group E and intravenous analgesia was provide for those in group P. General patient information was recorded and peripheral blood neutrophil counts, C-reactive protein (CRP) levels and interleukin (IL)-6 concentrations were measured immediately prior to the surgery (T 0), and at 24, 48 and 72 h after the procedure (T 1 , T 2 and T 3 , respectively). Visual analog scale (VAS) scores were also recorded at T 1 , T 2 and T 3 , and the mini-mental state evaluation (MMSE) scores at T 0 , T 1 , T 2 , and T 3 were calculated. Patients were diagnosed as having POCD according to their MMSE score differences between the peri-operative and post-operative values. The results revealed that the levels of CRP and IL-6 significantly increased in both groups after the surgery (T 1-3). However, the CRP and IL-6 levels in group E were significantly lower than those in group P at all time points examined (P<0.05). The VAS scores in group E at T 1 , T 2 and T 3 were significantly lower than those in group P (P<0.05). Finally, the incidence of POCD in group E was significantly lower than that in group P (P<0.05). On the whole, the post-operative epidural analgesia reduced the systemic inflammatory response, the perceived pain, and the incidence of POCD in patients undergoing radical resection of cervical cancer, when compared with the effects of intravenous analgesia.

Effect of Systemic Lidocaine on Postoperative Early Recovery Quality in Patients Undergoing Supratentorial Tumor Resection

“… 31 , 32 It was obvious that higher pain scores in our study significantly lowered postoperative recovery quality, especially POH 12 and POH 24; and this was consistent with the study by Licina et al 33 Pain not only causes short-term or long-term fluctuations in hemodynamics, but also delays brain function returning to normal levels, leading to postoperative cognitive dysfunction or abnormal mental activity; afterwards it slows down the postoperative recovery process. 34 , 35 The former was revealed by lower fluctuations of intraoperative hemodynamic parameters (such as MAP and HR) and lower utilization of vasoactive drugs in our study; and the incidence and extent of agitation reduced significantly during extubation, suggesting that lidocaine played a positive role in postoperative brain function recovery. Furthermore, there was no significant difference in peripheral fluid infusion between groups in this study.…”

Early Cognitive Dysfunction in Elderly Patients after Total Knee Arthroplasty: An Analysis of Risk Factors and Cognitive Functional Levels

“…The administration of effective analgesics to elderly patients might have benefits in preventing cognitive decline in some domains [39]. Compared with the effects of intravenous analgesia, the postoperative epidural analgesia decreased the systemic inflammatory response, the perceived pain, and the incidence of POCD [40,41]. Preemptive analgesia induced by a continuous femoral nerve block may promote the recovery of early cognitive function in elderly patients following TKA [42].…”

Comparison of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway and nerve block for intertrochanteric fracture surgeries in elderly patients: a retrospective cohort study

“…In addition, combined spinal-epidural anesthesia was also superior to general anesthesia with intubation in terms of postoperative cognitive function. We speculate that the relatively poor postoperative cognitive function of patients receiving general anesthesia with intubation was associated with the residual systemic analgesics, which might inhibit the central nervous system [16][17][18][19]. In addition to analgesics, pain may also contribute to the development of postoperative cognitive dysfunction [20][21][22].…”