DOI: https://doi.org/10.22141/2224-0586.8.103.2019.192379

Influence of premedication and anaesthesia on agitation and postoperative cognitive function during lumbar spine surgery

M.V. Lyzohub, M.A. Georgiyants, K.I. Lyzohub

Abstract


Background. Lumbar spine surgery may be performed under general (GA) or spinal (SA) anaesthesia with different postoperative analgesia regimen. The influence of these two factors is not fully studied. The study aimed to determine the influence of premedication and anaesthesia on preoperative agitation and postoperative cognitive function during lumbar spine surgery. Material and methods. We examined 254 ASA I–II patients aged 18–70 years undergone lumbar spine surgery. The patients were operated under SA or GA and obtained either standard postoperative analgesia (StA) or multimodal analgesia (MMA). StA included intravenous paracetamol 1.0 g 3 times per day and morphine by requirement. Those patients were premedicated with phenazepam 0.5 mg. MMA patients obtained additionally pregabalin 75 mg orally twice a day with preope­rative start and parecoxib 40 mg twice a day. Agitation was assessed with APAIS-A scale and cognitive functions — with Connect-the-Numbers Test (CNT). Results. Premedication with phenazepam and pregabalin had an equal influence on the level of preoperative agitation. We could not find any statistical difference between the groups in the level of APAIS-A scale. CNT did not differ between the groups before surgery. On postoperative day 3, in patients who received StA and phenazepam premedication, CNT was higher than the preoperative level (in group SA-StA 87.3 ± 27,2 sec vs 63.1 ± 16.3 sec, р < 0.05; in group GA-StA 92.1 ± 25.1 sec vs 61.1 ± 18.5 sec, р < 0.05), and it was higher than in patients of MMA groups (87.3 ± 27.2 sec vs 57.4 ± 23.8 sec, р < 0.05, in spinal anesthesia groups and 92.1 ± 25.1 sec vs 61.8 ± 19.8 sec, р < 0.05 in general anesthesia groups). Conclusions. Pregabalin used for MMA has an anxiolytic effect, that is equal to benzodiazepines. Unlike pregabalin, phenazepam lowers the dexterity and the ability to combine tasks up to 3 days after surgery. Premedication and postoperative analgesia, but not anaesthesia type, influence the post­operative cognitive function.


Keywords


lumbar spine surgery; surgical treatment; cognitive function; anesthesia

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