Relationship among anesthesia technique, surgical stress, and cognitive dysfunction following spinal surgery: a randomized trial

• Published in: Journal of neurosurgery. Spine Vol. 31; no. 6; p. 894
• Main Authors: Ezhevskaya, Anna A, Ovechkin, Alexei M, Prusakova, Zhanna B, Zagrekov, Valery I, Mlyavykh, Sergey G, Anderson, D Greg
• Format: Journal Article
• Language: English
• Published: United States 01.12.2019
• Subjects: epidural anesthesia; spinal surgery; stress response; postoperative cognitive dysfunction; immune suppression
• ISSN: 1547-5646
• DOI: 10.3171/2019.4.SPINE184

Surgical trauma is known to result in systemic inflammatory changes that can lead to postoperative cognitive dysfunction. In the present study, the authors compared the effects of an epidural anesthesia protocol to those of traditional anesthesia with regard to postoperative inflammatory changes, cellular immunity, and cognitive dysfunction. Forty-eight patients, ages 45-60 years, underwent multilevel thoracolumbar decompression and fusion and were randomly assigned to one of two groups: group 1 (27 patients) had combined epidural and general anesthesia, followed by epidural analgesia for 48 hours after surgery, and group 2 (21 patients) had general anesthesia, followed by traditional opioid pain management after surgery. At multiple time points, data on pain control, cognitive function, cellular immunity, and inflammatory markers were collected. Group 1 patients demonstrated lower pain levels, less systemic inflammation, less cellular immune dysfunction, and less postoperative cognitive dysfunction than group 2 patients. The use of combined epidural and general anesthesia followed by postoperative epidural analgesia during the first 48 hours after multilevel thoracolumbar decompression and fusion surgery had a significant positive effect on pain management, cellular immune function, systemic inflammation, and postoperative cognitive function.Clinical trial registration no.: 115080510080 (http://rosrid.ru).