Preoperative Chronic Pain as a Risk Factor for Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Hip Joint Replacement Surgery: A Prospective Observational Cohort Study

Huai, X; Jiao, Yuming; Gu, Xiaosong; Zhu, Hai‐Liang; L, Chen; Lu, Binfeng; Fan, Yan; Wang, Yu; Su, D.; H, Xie

doi:10.21203/rs.3.rs-46914/v1

Cited by 3 publications

(2 citation statements)

References 34 publications

(37 reference statements)

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“…Further evolution of various types of chronic inflammation leads to the occurrence of central chronic insidious inflammation. POCD is affected by stimulation such as anesthesia and surgery or hypoxia in the brain 18–20 . Previous studies of our research group also found that activation of microglia caused by inflammasomes may lead to POCD in rats 21 .…”

Section: Discussionsupporting

confidence: 55%

Study on painless gastroscopy and POCD of smoking patients under general anesthesia

Zhu

Yang

et al. 2022

Ibrain

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The number of smoking patients receiving anesthesia and surgical treatment is increasing day by day. It will be useful for medical advancement to explore whether smoking is an independent risk factor for postoperative cognitive impairment. A double-blind, parallel, and controlled study was conducted on 112 patients who fulfilled the criteria for inclusion in this study and planned to undergo painless gastroscopy under general anesthesia. The baseline mini-mental state examination (MMSE) scores and basic information were collected. The changes in the MMSE scores after waking up and 3 days after anesthesia were observed, and the adverse events (respiratory adverse reactions, circulatory fluctuations, and adverse reactions, drug use, etc.) were analyzed by logistic regression. The baseline level of each group is consistent, which is worth studying. The MMSE score of the smoking group after anesthesia was significantly different from that of the control group (p < 0.05), but there was no significant difference between the two groups 3 days after anesthesia.Among them, the differences in adverse events between the two groups were in terms of hiccup, postoperative cough, and SpO 2 < 90% (p < 0.05). Regression analysis indicates that smoking after anesthesia leads to the occurrence of postoperative cough. Smoking is probably an independent risk factor for postoperative cognitive dysfunction (POCD) in early postoperative patients.

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Section: Discussionsupporting

confidence: 55%

Study on painless gastroscopy and POCD of smoking patients under general anesthesia

Zhu

Yang

et al. 2022

Ibrain

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“…It has been proved that both preoperative chronic and postoperative acute pain can impair postoperative cognitive function [18] . Uncontrolled severe postoperative pain increases morbidity after hip surgery, and providing patients with adequate analgesia can promote early postoperative rehabilitation [19] .…”

Section: Discussionmentioning

confidence: 99%

Effects of anterior approach to quadratus lumborum block on postoperative cognitive function following hip surgery in elderly patients: A randomized controlled clinical trial

Zhu

Mei

Zhou

et al. 2023

Preprint

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Background: Peripheral nerve block, including the quadratus lumborum block (QLB), has been used for postoperative analgesia in hip surgery. However, the effects of QLB on cognitive function after hip surgery remain unknown. This study aimed to assess the effects of the anterior approach to QLB on postoperative cognitive function in elderly patients undergoing hip surgery. Methods: Sixty elderly patients who underwent hip surgery from May 2021 to May 2022 were randomly divided into the QLB (n = 30) and control groups (n = 30). The Montreal Cognitive Assessment (MoCA) score was measured one day preoperatively and seven and 30 days postoperatively. The incidence of postoperative cognitive dysfunction (POCD) was examined seven and 30 days postoperatively. The visual analog scale (VAS) scores at rest and Bruggrmann comfort scale (BCS) scores 6 h (t1), 12 h (t2), 24 h (t3), and 48 h (t4) after surgery were assessed. The plasma high mobility group box protein 1 (HMGB1) and levels of interleukin-6 (IL-6) were evaluated 1 h preoperatively (baseline) and 24 h postoperatively (day 1). The requirement for rescue analgesia, time to first off-bed activity, and adverse effects after surgery were also recorded. Results: Compared with the control group, the incidence of POCD was significantly lower in the QLB group seven days postoperatively (10.7% vs. 34.5%, P = 0.033), but no difference at 30 days postoperatively (3.6% vs. 10.3%, P = 0.317). There was no significant difference in MoCA scores between the two groups at one day preoperatively and 30 days postoperatively. However, the MoCA scores at seven days postoperatively were higher in the QLB group than in the control group (P < 0.05). In the QLB group, the VAS scores at t1, t2, and t3 were lower, and the BCS scores at t1, t2, and t3 were higher than those in the control group (P < 0.05). The patients in the QLB group reported significantly fewer requirements for rescue analgesia (P < 0.05). The plasma levels of HMGB1 and IL-6 at 24 h postoperatively in the QLB group were significantly lower than in the control group (P < 0.05). The time to first off-bed activity was shorter in the QLB group (P < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups. Conclusions: Anterior QLB given to elderly patients undergoing hip surgery could promote early postoperative cognitive function recovery, provide adequate postoperative analgesia, and inhibit the release of inflammatory factors. Trial registration: Chictr.org.cn identifier ChiCTR2000040724 (Date of registry: 08/12/2020, prospectively registered).

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Evaluation of the Efficacy of Fascia Iliaca Compartment Block in Maintaining Cognitive Function Post-Surgery in Elderly Individuals with Hip Fractures

NIYONKURU,

Zhang,

2024

International Journal of Innovative Science and Research Techno

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Postoperative cognitive dysfunction (POCD) is a prevalent issue among elderly hip fracture patients’ post- surgery period, leading to cognitive decline and prolonged recovery. This narrative review delves into the efficacy of Fascia Iliaca Compartment Block (FICB) in addressing POCD. FICB, a targeted anesthetic approach, not only provides efficient pain management but also reduces inflammation and minimizes opioid reliance in the elderly. By alleviating pain and inflammation, FICB facilitates enhanced early postoperative mobility, potentially lowering the likelihood of cognitive dysfunction. Research indicates that FICB can decrease tau protein levels and inflammatory markers, attenuating the inflammatory cascade linked to cognitive impairment. Moreover, FICB's ability to offer localized pain relief without systemic opioid repercussions aids in preventing complications like delirium. The utilization of FICB emerges as a pivotal strategy in optimizing postoperative outcomes and diminishing POCD incidence in elderly hip fracture patients. Further exploration and integration of FICB in clinical practice hold promise for enhancing the care of this vulnerable patient cohort.

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Preoperative Chronic Pain as a Risk Factor for Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Hip Joint Replacement Surgery: A Prospective Observational Cohort Study

Cited by 3 publications

References 34 publications

Study on painless gastroscopy and POCD of smoking patients under general anesthesia

Study on painless gastroscopy and POCD of smoking patients under general anesthesia

Effects of anterior approach to quadratus lumborum block on postoperative cognitive function following hip surgery in elderly patients: A randomized controlled clinical trial

Evaluation of the Efficacy of Fascia Iliaca Compartment Block in Maintaining Cognitive Function Post-Surgery in Elderly Individuals with Hip Fractures

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