The Influence of Anesthesia and Pain Management on Cognitive Dysfunction After Joint Arthroplasty: A Systematic Review

Abstract

Background Despite the overall success of total joint arthroplasty, patients undergoing this procedure remain susceptible to cognitive decline and/or delirium, collectively termed postoperative cognitive dysfunction. However, no consensus exists as to whether general or regional anesthesia results in a lower likelihood that a patient may experience this complication, and controversy surrounds the role of pain management strategies to minimize the incidence of postoperative cognitive dysfunction.Questions/purposes We systematically reviewed the English-language literature to assess the influence of the following anesthetic and/or pain management strategies on the risk for postoperative cognitive dysfunction in patients undergoing elective joint arthroplasty: (1) general versus regional anesthesia, (2) different parenteral, neuraxial, or inhaled agents within a given type of anesthetic (general or regional), (3) multimodal anesthetic techniques, and (4) different postoperative pain management regimens. Methods A systematic search was performed of the MEDLINE 1 and EMBASE TM databases to identify all studies that assessed the influence of anesthetic and/or pain management strategies on the risk for postoperative cognitive dysfunction after elective joint arthroplasty. Twenty-eight studies were included in the final review, of which 21 (75%) were randomized controlled (Level I) trials, two (7%) were prospective comparative (Level II) studies, two (7%) used a case-control (Level III) design, and three (11%) used retrospective comparative (Level III) methodology.

Delirium: actualización en manejo no farmacológico

“…Otra medida general que se aconseja favorecer es la mantención de un tránsito intestinal apropiado, con el fin de evitar complicaciones como fecaloma o retención urinaria 11,19,21 . Conjuntamente se debe utilizar analgesia en caso de dolor, chequeando diariamente la presencia de éste en relación a procedimientos quirúrgicos 24 , patologías osteoarticulares 25 , lesiones por úlceras, contenciones físicas 26 o secundario a vías venosas 27 . Mejorar la calidad del sueño con estrategias como el disminuir el ruido ambiental y reducir la iluminación durante la noche, han demostrado minimizar la incidencia de delirium 28 , según un estudio realizado por anestesistas en una unidad de cuidados intensivos en el Reino Unido 29 .…”

Manejo Anestésico Y Analgésico Del Paciente Ortogeriátrico

“…Aunque el desarrollo de este cuadro es multifactorial, el dolor postoperatorio mal manejado puede ser una de las causas contribuyentes más importantes, aumentando el riesgo en relación a una valoración más alta del dolor 29 . El delirium postoperatorio se ha asociado a un aumento de la mortalidad 30 . Se asocia a una tardanza en el inicio de la deambulación, del alta hospitalaria, mayor probabilidad de disfunción cognitiva luego del alta, mayor incidencia de reingreso hospitalario y a una menor probabilidad de recuperación de la capacidad para realizar actividades básicas de la vida diaria 8 .…”

Postoperative Cognitive Dysfunction: Preclinical Highlights and Perspectives on Preventive Strategies

“…Furthermore, there appears to exist an association between postoperative pain and cognitive impairment, exerting an inluence over the patients' performance on certain cognitive tests [26][27][28]. Apart from the efect of the pain, the inluence of postoperative analgesics should not be ruled out.…”

“…In fact, successful postoperative pain management may be important in preventing POCD in elderly patients [35]. Additionally, cognitive impairment in elderly patients may also be inluenced by stress produced by the hospitalization itself, the postoperative fatigue state, the unfamiliar environment and sleep deprivation [12,28,29].…”