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, Xiaorong; Jiao, Yingfu; Gu, Xiechong; Zhu, Haiqin; Chen, Lingke; Fan, Yichen; Yu, Weifeng; Su, Diansan; Xie, Hong

doi:10.3389/fnins.2021.747362

Cited by 11 publications

(11 citation statements)

References 40 publications

(43 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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“…Pain may be one of the variables that influence altered cognitive performance and promote its deterioration (Chen et al, 2019 ; Ding et al, 2021 ). The occurrence of POCD can be reduced through proper pain evaluation, sufficient analgesia, and prevention of the transition from acute to chronic pain (Huai et al, 2021 ; Vacas et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Fascia iliaca compartment block can reduce the incidence of early post-operative cognitive impairment in elderly patients with high-risk hip replacement

Guo

et al. 2022

Front. Aging Neurosci.

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ObjectiveIn this study, we aimed to observe the effects of ultrasound-guided fascia iliaca compartment block (FICB) combined with hypobaric spinal anesthesia on post-operative pain and cognitive function in elderly patients with high-risk hip replacement.MethodsA total of 84 elderly patients—aged 65–85 years, with American Society of Anesthesiologists physical status III–IV, and scheduled for hip arthroplasty between September 2021 and May 2022—were selected. One or more organs with moderate to severe impairment were included in all patients. The patients were randomly divided into a hypobaric spinal anesthesia group (group C, control group) and an ultrasound-guided FICB combined with hypobaric spinal anesthesia group (group E, experimental group). Group C was given 3.5 mL of 0.32% ropivacaine hypobaric spinal anesthesia, and group E received ultrasound-guided FICB combined with 3.5 mL of 0.32% ropivacaine hypobaric spinal anesthesia. The patients were compared using the visual analog scale (VAS) for pain, Harris hip function score, and simple Mini-Mental State Examination (MMSE) scale. Blood β-amyloid (Aβ) and neuronal microtubule-associated protein (tau) levels were measured. We compared intraoperative conditions and post-operative complications between the two groups to assess the effects of FICB combined with hypobaric spinal anesthesia on post-operative pain and cognitive function in elderly patients with high-risk hip replacement.ResultsAt 1 and 3 days after the operation, patients in group C had significantly higher VAS and lower MMES scores than those in group E. The differences were statistically significant at 1 (P < 0.01) and 3 (P < 0.05) days after the operation. At 1 day after operation, the Harris score of patients in group C was significantly lower than that of patients in group E (P < 0.05). The Aβ and tau levels of patients in group C were significantly higher than those of patients in group E at 1 day after the operation (P < 0.01). The Aβ levels of patients in group C were significantly higher than those of patients in group E at 3 days after the operation (P < 0.05). The intraoperative conditions and post-operative complication rates did not differ significantly between the two groups. At 1 day before and 5 days after the operation, there was no difference in any of the indicators.ConclusionBy lowering pain and managing Aβ and tau protein concentrations, FICB can successfully lower the incidence of early post-operative cognitive impairment in elderly patients with high-risk hip replacement.Clinical trial registrationwww.chictr.org.cn, identifier: ChiCTR2100051162.

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“…Our central hypothesis was that at the time people first reported pain (at baseline, incident, or as more persistent), they would have a lower cognitive function and greater cognitive decline thereafter. Not only is this suggested by general cross-sectional studies of pain and cognitive function (Karp et al, 2006;Oosterman et al, 2011;van der Leeuw et al, 2016) but also recent studies of baseline pain, incident pain, and pain persistence (Bell, Pope, Downer, et al, 2021;Duggleby & Lander, 1994;Huai et al, 2021).…”

mentioning

confidence: 99%

“…Of those that have examined incident pain, two studies found that older adults who developed pain after surgery were more likely to have cognitive impairment from 3 days (Duggleby & Lander, 1994) to 2 years later (Huai et al, 2021), even after that pain subsided and after accounting for the effects of anesthesia. Furthermore, a recent study in community-dwelling Puerto Rican older adults found that incident pain was related to changes in cognitive status (via a dementia screening assessment), whereas persistent pain was not (Bell, Pope, Downer, et al, 2021).…”

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confidence: 99%

Longitudinal associations of pain and cognitive decline in community-dwelling older adults.

Bell¹,

Sprague²,

Ross³

2022

Psychology and Aging

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Pain is inversely associated with cognitive function in older adults, but the effects of pain on cognitive decline are not fully clear. This study examined the associations of baseline pain, pain persistence, and incident pain with changes in cognition across 10 years in a sample of healthy community-dwelling older adults (n = 688; M age = 74, SD = 6.05) from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. While ACTIVE was a four-arm single-blind cognitive training randomized controlled trial, the present study includes only participants from the no-contact control group. Pain was examined using the Medical Outcomes Survey SF-36-Item (MOS SF-36) and cognitive tests examined simple processing speed, complex processing speed, divided and selective attention, memory, reasoning, and cognitive status. Multilevel models tested the associations of baseline pain, incident pain, and pain persistence on cognitive function and cognitive decline, adjusted for baseline age, time (years after followup), race, gender, education, marital status, and depressive symptoms at baseline and over time. Thirty-one percent reported pain at baseline which was related to worse baseline memory and accelerated decline in processing speed. Forty-two percent of older adults reported incident pain had accelerated decline in complex processing speed, divided attention, memory, reasoning, and cognitive status. On average, older adults reported a mean of two waves of pain persistence related to accelerated decline in memory. In sum, pain is common in community-dwelling older adults and is related to accelerated cognitive decline, especially when the incident. Public Significance StatementPain in later life is related to cognitive decline in older adults and may serve as a key target to curtail poorer cognition in later life.

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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 11 publications

References 40 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

Fascia iliaca compartment block can reduce the incidence of early post-operative cognitive impairment in elderly patients with high-risk hip replacement

Longitudinal associations of pain and cognitive decline in community-dwelling older adults.

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