Influence of premedication and anaesthesia on agitation and postoperative cognitive function during lumbar spine surgery
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.
Full Text:PDF (Українська)
Martin B., Mirza S., Spina N., Spiker W., Lawrence B., Brodke D. Trends in Lumbar Fusion Procedure Rates and Associated Hospital Costs for Degenerative Spinal Diseases in the United States, 2004–2015. Spine. 2018. Vol. 4. № 5. P. 369-376.
Aust H., Eberhart L., Sturm T., Schuster M., Nestoriuc Y., Brehm F., Rüsch D. A cross-sectional study on preoperative anxiety in adults. Journal of Psychosomatic Research. 2018. Vol. 111. P. 133-39.
Rundshagen I. Postoperative Cognitive Dysfunction. Dtsch. Arztebl. Int. 2014. Vol. 111(8). P. 119-25.
Guay J. General anaesthesia does not contribute to long-term post-operative cognitive dysfunction in adults: A meta-analysis. Indian J. Anaesth. 2011. Vol. 55(4). P. 358-63.
Bilotta F., Qeva E., Matot I. Anesthesia and cognitive disorders: a systematic review of the clinical evidence. Journal Expert Review of Neurotherapeutics. 2016. Vol. 16(11). P. 1311-1320.
Eckenhoff R., Laudansky K. Anesthesia, Surgery, Illness and Alzheimer’s Disease. Prog. Neuropsychopharmacol. Biol. Psychiatry. 2013. Vol. 47. P. 162-166.
Moerman N., van Dam F., Muller M., Oosting H. The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesthesia & Analgesia. 1996. Vol. 82(3). P. 445-451.
Singh D., Yadav J., Jamuda B., Singh P. Oral Pregabalin as Premedication on Anxiolysis and Stress Response to Laryngoscopy and Endotracheal Intubation in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Double-Blind Study. Anesth. Essays Res. 2019. Vol. 13(1). P. 97-104.
Gebhardt V., Kiefer K., Weiss C., Schmittner M. Influence of anxiolytic premedication on vasovagal reactions and home readiness following outpatient intrathecal anaesthesia — A retrospective analysis. Acta Anaesthesiol. Scand. 2019. Vol. 63(4). P. 468-474.
Maurice-Szamburski A., Auquier P., Viarre-Oreal V., Cuvillon P., Carles M., Ripart J. et al. Effect of Sedative Premedication on Patient Experience After General Anesthesia. A Randomized Clinical Trial. JAMA. 2015. Vol. 313(9). P. 916-925.
Stephenson J., Golz D., Brasher M. Phenazepam and its Effects on Driving. Journal of Analytical Toxicology. 2013. Vol. 37. P. 25-29.
Wu C., Hsu W., Richman J. Postoperative cognitive function as an outcome of regional anesthesia and analgesia. Reg. Anesth. Pain Med. 2004. Vol. 29. P. 257-268.
Mason S., Noel-Storr A., Ritchie C. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. J. Alzheimers. Dis. 2010. Vol. 22(Suppl. 3). P. 67-79.
Zywiel M., Prabhu A., Perruccio A., Gandhi R. The Influence of Anesthesia and Pain Management on Cognitive Dysfunction After Joint Arthroplasty: A Systematic Review. Clin. Orthop. Relat. Res. 2014. Vol. 472(5). P. 1453-1466.
Wei Yan, Huajie Mao, Ping Qiu. Effects of different analgesia regimens on early post-operative cognitive dysfunction in elderly patients undergoing radical resection of cervical carcinoma. Exp. Ther. Med. 2019. Vol. 18(2). P. 1465-1469.
Copyright (c) 2020 EMERGENCY MEDICINE
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2020