Protective effect of combined general and regional anesthesia on postoperative cognitive function in older arthroplasty patients

Purpose: Postoperative cognitive dysfunction (POCD) occurs frequently in elderly people especially for those after major surgeries. Arthroplasty improves quality of life in elderly patients but is associated with high incidence of POCD. The problem that whether the different anesthesia methods have effects on POCD has long been a controversy. The objective of this study was to observe whether combined general and regional anesthesia affected perioperative cognitive trajectory in elderly patients with arthroplasty. Methods: Ninety patients with knee and hip arthroplasty aged between 60 yr and 79 yr were randomly allocated to general anesthesia group or combined general and regional anesthesia groups. Mini-mental state examination (MMSE) was performed to assess cognitive function changes before and at one week after surgery. Results: The postoperative MMSE was significantly higher in the combined anesthesia group than in the general anesthesia group (p=0.005). The postoperative MMSE score was significantly improved compared with preoperative MMSE score in both groups (p < 0.05). Conclusions: Our study demonstrated that combined general and regional anesthesia protected perioperative cognitive trajectory, providing evidence supporting use of regional anesthesia along with general anesthesia in elderly orthopedic patients who are vulnerable to postoperative cognitive decline.