Effects of combined spinal-epidural anesthesia on postoperative pain and short-term cognitive function in elderly patients undergoing hip fracture surgery / 中国医师进修杂志

ABSTRACT

Objective:To investigate the effects of combined spinal-epidural anesthesia (CSEA) on postoperative pain and short-term cognitive function in elderly patients undergoing hip fracture surgery.Methods:A total of 60 elderly patients undergoing hip fracture surgery in Dongchangfu District of Liaocheng People′s Hospital from October 2018 to September 2020 were selected as subjects and they were divided into the control group and the observation group by performed different anaesthesias methods, with 30 patients in each group. The control group underwent total intravenous anesthesia (TIVA), and the observation group underwent CSEA. The scores of visual analogue scale (VAS) at different points and the analgesic recovery rate within 48 h of the two groups were compared, and mini mental state evaluation (MMSE) scores of two groups at different points were evaluated. The levels of serum interleukin (IL)-6, IL-10 and tumor necrosis factor-α (TNF-α) of the two groups before the surgery and on the 1 d after the surgery were compared, and adverse events after the surgery were observed.Results:The analgesic recovery rate within 48 h in the observation group was lower than that in the control group 3.33%(1/30) vs. 26.67%(8/30), the difference was statistically significant ( χ2 = 6.40, P<0.05). The VAS scores at 4, 6, 12, 24, 48 h after the surgery in the observation group were lower than those in the control group ( P<0.05). The scores of MMSE at 1 and 3 d after the surgery in the observation group were higher than those in the control group (25.38 ± 2.86) scores vs. (22.17 ± 2.72) scores, (26.89 ± 3.04) scores vs. (25.17 ± 2.69) scores, the differences were statistically significant ( P<0.05). At 1 d after the surgery, the levels of IL-6, TNF-α in the observation group were lower than those in the control group (67.59 ± 15.47) ng/L vs. (86.75 ± 17.88) ng/L, (18.75 ± 4.23) ng/L vs. (22.81 ± 4.30) ng/L; and the level of IL-10 was higher than that in the control group (39.78 ± 8.31) ng/L vs. (34.76 ± 7.54) ng/L, the differences were statistically significant ( P<0.05). There was no statistical difference in the total incidence of postoperative adverse events between the two groups ( P>0.05). Conclusions:CSEA can effectively relieve postoperative pain, improve short-term cognitive function, reduce inflammatory response in elderly patients with hip fracture surgery, and with great safety.