Influence of postoperative analgesia on systemic inflammatory response and postoperative cognitive dysfunction after femoral fractures surgery: a randomized controlled trial

Abstract

Background and objectivesTo investigate the possible effect of postoperatively applied analgesics—epidurally applied levobupivacaine or intravenously applied morphine—on systemic inflammatory response and plasma concentration of interleukin (IL)-6 and to determine whether the intensity of inflammatory response is related to postoperative cognitive dysfunction (POCD).MethodsThis is a randomized, prospective, controlled study in an academic hospital. Patients were 65 years and older scheduled for femoral fracture fixation from July 2016 to September 2017. Inflammatory response was assessed by leukocytes, neutrophils, C reactive protein (CRP) and fibrinogen levels in four blood samples (before anesthesia, 24 hours, 72 hours and 120 hours postoperatively) and IL-6 concentration from three blood samples (before anesthesia, 24 hours and 72 hours postoperatively). Cognitive function was assessed using the Mini-Mental State Examination preoperatively, from the first to the fifth postoperative day and on the day of discharge.ResultsThe study population included 70 patients, 35 in each group. The incidence of POCD was significantly lower in the levobupivacaine group (9%) than in the morphine group (31%) (p=0.03). CRP was significantly lower in the levobupivacaine group 72 hours (p=0.03) and 120 hours (p=0.04) after surgery. IL-6 values were significantly lower in the levobupivacaine group 72 hours after surgery (p=0.02). The only predictor of POCD in all patients was the level of IL-6 72 hours after surgery (p=0.03).ConclusionsThere is a statistically significant association between use of epidural levobupivacaine and a reduction in some inflammatory markers. Postoperative patient-controlled epidural analgesia reduces the incidence of POCD compared with intravenous morphine analgesia in the studied population.Trial registration numberNCT02848599.

Relationship between Artificial Intelligence-Based General Anesthetics and Postoperative Cognitive Dysfunction

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Lithium chloride ameliorates cognition dysfunction induced by sevoflurane anesthesia in rats

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Effect of perioperative intravenous lidocaine on the incidence of short‐term cognitive function after noncardiac surgery: A meta‐analysis based on randomized controlled trials

“…Postoperative cognitive dysfunction (POCD) is a debilitating surgical complication (Smith et al, 2018), characterized by symptoms such as memory deterioration, loss of concentration, attention-deficit disorder, mental disorders, and even personality change (Newman et al, 2001). Studies showed that POCD can occur after all types of surgery, not just after heart surgery (Edipoglu & Celik, 2019;Holmgaard et al, 2019;Kristek et al, 2019). The reported incidence of POCD is 26% within a few weeks which decreased to 10% 3 months after noncardiac surgery (Brown & Purdon, 2013).…”