Kun Wang1, Chengwen Li2, Jihong Shi, Hongtu Wei. 1. Department of Anesthesiology, Jining NO.1 People's Hospital, Jining 272011, China. 2. Email: lichwen2008@126.com.
Abstract
OBJECTIVE: To explore the effect of patient-controlled intravenous analgesia (PCIA) with dexmedetomidine and sufentanil on early postoperative cognition in elderly patients after spine surgery. METHODS:One hundred fifty-two patients aged more than 60 yr with ASA I-III undergoing elective spine surgery were randomly assigned into two groups: Group S received PCIA with only sufentanil (n=77); Group D received PCIA with dexmedetomidine and sufentanil (n=75). The severity of pain at rest and upon movement was measured at 1, 2, 6, 12, 24 and 48 h after surgery using the 11-point numerical rating scale (NRS). Delirium was assessed daily within three days after surgery via the confusion assessment method. Cognitive function was measured at the day before surgery and at one week after surgery using a battery of neuropsychologic tests including Digit Span (forward and backward) subtests and Visual Retention and Paired Associate Verbal Learning subtests of Wechsler Memory Scale, Stroop Color Word Interference Test, Digit Symbol Substitution subtest of Wechsler Adult Intelligence Scale (DSST) and Trail Making Test (Part A). RESULTS: The NRS scores at rest and upon movement at 6 to 48 h after surgery were lower in Group D than those in Group S (P<0.05). Postoperative delirium (POD) was present in 8 (10.4%) patients in Group S and 3 (4.0%) patients in Group D (χ2=4.206, P>0.05). Two patients with POD in Group S were treated with risperidone. Postoperative cognitive dysfunction (POCD) was present in 15 (19.5%) patients in Group S and 6 (8.0%) patients in Group D (χ2=4.206, P<0.05). Compared with the preoperative baselines, the scores of Digit Span backward, Visual Retention and DSST were significantly lower (3.7±1.3 vs 4.1±1.1, 7.7±2.0 vs 8.8±1.8, 25.2±7.8 vs 28.2±7.6; t=2.132, 3.585, 2.427, respectively, P<0.05) and the time to complete Stroop test was significantly longer in Group S (56.9±14.8 vs 50.2±14.7, t=-2.822, P<0.05), while only the score of Digit Span backward was significantly lower in Group D (3.6±1.2 vs 4.0±1.2, t=2.144, P<0.05). CONCLUSION:Dexmedetomidine combined with sufentanil in postoperative PCIA can result in superior analgesia and improve early postoperative cognitive function.
RCT Entities:
OBJECTIVE: To explore the effect of patient-controlled intravenous analgesia (PCIA) with dexmedetomidine and sufentanil on early postoperative cognition in elderly patients after spine surgery. METHODS: One hundred fifty-two patients aged more than 60 yr with ASA I-III undergoing elective spine surgery were randomly assigned into two groups: Group S received PCIA with only sufentanil (n=77); Group D received PCIA with dexmedetomidine and sufentanil (n=75). The severity of pain at rest and upon movement was measured at 1, 2, 6, 12, 24 and 48 h after surgery using the 11-point numerical rating scale (NRS). Delirium was assessed daily within three days after surgery via the confusion assessment method. Cognitive function was measured at the day before surgery and at one week after surgery using a battery of neuropsychologic tests including Digit Span (forward and backward) subtests and Visual Retention and Paired Associate Verbal Learning subtests of Wechsler Memory Scale, Stroop Color Word Interference Test, Digit Symbol Substitution subtest of Wechsler Adult Intelligence Scale (DSST) and Trail Making Test (Part A). RESULTS: The NRS scores at rest and upon movement at 6 to 48 h after surgery were lower in Group D than those in Group S (P<0.05). Postoperative delirium (POD) was present in 8 (10.4%) patients in Group S and 3 (4.0%) patients in Group D (χ2=4.206, P>0.05). Two patients with POD in Group S were treated with risperidone. Postoperative cognitive dysfunction (POCD) was present in 15 (19.5%) patients in Group S and 6 (8.0%) patients in Group D (χ2=4.206, P<0.05). Compared with the preoperative baselines, the scores of Digit Span backward, Visual Retention and DSST were significantly lower (3.7±1.3 vs 4.1±1.1, 7.7±2.0 vs 8.8±1.8, 25.2±7.8 vs 28.2±7.6; t=2.132, 3.585, 2.427, respectively, P<0.05) and the time to complete Stroop test was significantly longer in Group S (56.9±14.8 vs 50.2±14.7, t=-2.822, P<0.05), while only the score of Digit Span backward was significantly lower in Group D (3.6±1.2 vs 4.0±1.2, t=2.144, P<0.05). CONCLUSION:Dexmedetomidine combined with sufentanil in postoperative PCIA can result in superior analgesia and improve early postoperative cognitive function.