Preoperative Chronic and Acute Pain Affects Postoperative Cognitive Function Mediated by Neurotransmitters

Ding, Xian; Gao, Xiang; Wang, Zhichun; Jiang, Xuliang; Lu, Shunmei; Xu, Jingjing; Qin, Guo‐Wei; Gu, Zhengfeng; Huang, Dongya

doi:10.1007/s12031-020-01673-x

Cited by 19 publications

(12 citation statements)

References 40 publications

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“…The mechanisms by which pain (acute and chronic pain) induces cognitive dysfunction are complex. Acute pain may aggravate postoperative cognitive dysfunction (such as memory deficits) via neurotransmitters (increased dopamine (DA) levels in the cortex and decreased acetylcholine (ACH) levels in the hippocampus) and by changing the levels of inflammatory factors [38]. The administration of effective analgesics to elderly patients might have benefits in preventing cognitive decline in some domains [39].…”

Section: Discussionmentioning

confidence: 99%

Early Cognitive Dysfunction in Elderly Patients after Total Knee Arthroplasty: An Analysis of Risk Factors and Cognitive Functional Levels

Ren

Fang

Yuan

et al. 2022

BioMed Research International

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Background. Cognitive dysfunction after total knee arthroplasty (TKA) is very common in elderly patients. Postoperative cognitive dysfunction (POCD), as a form of cognitive dysfunction, may affect patients’ short- and long-term recoveries. The identification of meaningful risk factors may help reduce the occurrence of POCD in the future. Objective. Our goal was to retrospectively investigate the risk factors for early POCD in elderly patients undergoing TKA and to further analyze the relationship between the intensity of risk factors and the level of cognitive function. Methods. The related indicators and the Montreal Cognitive Function Assessment Scale (MOCA) scores of 105 elderly patients were collected by searching the electronic case system. According to the postoperative MOCA score, patients were divided into three groups: normal group (group N), mild POCD group (group M), and severe POCD group (group S). SPSS 25.0 software was used for statistical analyses. Results. At baseline, the preoperative MOCA score was significantly different in patients with POCD ( P ≤ 0.001 ), while other baseline indicators were not significantly different. In terms of changes in hemoglobin levels, statistically significant differences were observed between group M, group S, and group N ( P = 0.039 ). Among inflammatory indicators, only postoperative CRP levels showed a statistically significant difference in patients with POCD ( P = 0.041 ). Postoperative pain was also significantly different among the three groups ( P = 0.009 ). The multivariate regression analysis revealed that a low preoperative MOCA score and severe postoperative pain were independent risk factors for mild and severe cognitive impairment, while a high postoperative CRP level was only an independent risk factor for mild cognitive impairment. Conclusions. Our study found that the level of preoperative cognitive function, postoperative CRP level, and postoperative pain were independent risk factors for POCD. Moreover, the levels of preoperative cognitive function and postoperative pain were more strongly correlated with severe POCD than postoperative CRP levels.

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Section: Discussionmentioning

confidence: 99%

Early Cognitive Dysfunction in Elderly Patients after Total Knee Arthroplasty: An Analysis of Risk Factors and Cognitive Functional Levels

Ren

Fang

Yuan

et al. 2022

BioMed Research International

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“…Cognitively impaired rats show increased levels of serum pro-inflammatory factors and changes in the concentrations of prefrontal cortex and hippocampal neurotransmitters such as dopamine, epinephrine, serotonin, acetylcholine (ACh), and GABA ( Ding et al, 2021 ). α-Synuclein, a protein containing 140 amino acids, is primarily located at the presynaptic terminal and maintains neurotransmitter homeostasis.…”

Section: Sevoflurane-inhalation Anesthesia and Pocdmentioning

confidence: 99%

Update on the Mechanism and Treatment of Sevoflurane-Induced Postoperative Cognitive Dysfunction

Wang

Chen

Zhang

et al. 2021

Front. Aging Neurosci.

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Sevoflurane is one of the most widely used anesthetics for the induction and maintenance of general anesthesia in surgical patients. Sevoflurane treatment may increase the incidence of postoperative cognitive dysfunction (POCD), and patients with POCD exhibit lower cognitive abilities than before the operation. POCD affects the lives of patients and places an additional burden on patients and their families. Understanding the mechanism of sevoflurane-induced POCD may improve prevention and treatment of POCD. In this paper, we review the diagnosis of POCD, introduce animal models of POCD in clinical research, analyze the possible mechanisms of sevoflurane-induced POCD, and summarize advances in treatment for this condition.

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“…Several factors, such as advanced age, cardiovascular illness, endocrine system disease, history of surgical anesthesia, and neurological alterations, are associated with the development of POCD. 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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Preoperative Chronic and Acute Pain Affects Postoperative Cognitive Function Mediated by Neurotransmitters

Cited by 19 publications

References 40 publications

Early Cognitive Dysfunction in Elderly Patients after Total Knee Arthroplasty: An Analysis of Risk Factors and Cognitive Functional Levels

Early Cognitive Dysfunction in Elderly Patients after Total Knee Arthroplasty: An Analysis of Risk Factors and Cognitive Functional Levels

Update on the Mechanism and Treatment of Sevoflurane-Induced Postoperative Cognitive Dysfunction

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

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