Postoperative Cognitive Function Following General Versus Regional Anesthesia

Abstract

The effect of anesthetic technique on post-operative outcomes remains in question. This systematic review compares the role of regional versus general anesthesia, with a particular focus on post-operative cognitive function. Potentially relevant articles were identified by searching publicly available computerized databases for this systematic review. Any surgical procedure was accepted with the exception of cardiac, carotid, and neurosurgical procedures. Any regional anesthetic technique was accepted unless combined with a general anesthetic or in conjunction with propofol as a sedative. Any measure of post-operative cognitive function was accepted as long as it was performed no sooner than seven days post-operatively. Sixteen studies met inclusion criteria and were included in the final analysis. Three studies showed some difference in cognitive function between regional and general anesthesia, while the remaining thirteen showed no difference between regional and general anesthesia on postoperative cognitive function.

Regional anaesthesia and outcomes

“…POCD can result in emotional distress to patients and relatives, impairment of recovery, prolonged hospital stay, and increased social and physical care requirements in the community. Whilst RA reduces pain and opioid consumption, modifies the surgical stress response, and may allow GA to be avoided, the most recent metaanalysis concluded that there is still no evidence that RA reduces POCD compared to GA. 8 Any analysis of POCD is complicated by heterogeneous assessments and definitions, as well as the use or not of sedation with RA, but there is also a suggestion that GA may be neuroprotective. A separate Cochrane review also failed to show any difference between central neuraxial blockade (CNB) or GA, and the risk of acute confusional state after a hip-fracture surgery.…”

Mild Cognitive Impairment and Exposure to General Anesthesia for Surgeries and Procedures: A Population-Based Case–Control Study

“…Current evidence suggests that there is no difference in incidence of POCD following regional vs. general anesthesia. 44 Thus, since surgeries performed under regional anesthesia only are not included in our study we cannot generalize our study results to reflect the association between any surgical exposure and the development of MCI. Furthermore, hospitalization without surgery, which may be associated with cognitive decline, was not accounted in any of our analyses.…”

Neurotoxicity caused by anesthetics in pediatric anesthesia

“…In another publication in 2016 did Ing et al state that children exposed to anesthesia and surgery before age 3 will show deficits primarily in language and cognition, but that behavioral deficits are not associated with exposure [20]. In 2014 reviewed Davis et al the published literature on possible differences between general anesthesia and regional anesthesia in the development of cognitive disorders when administered at young age [21]. They concluded that the available studies did not allow to decide that such a difference exists nor that either techniques result in cognitive dysfunctions.…”