Effects of epidural block anesthesia combined with general anesthesia on cognitive function and analgesic effect after thoracoscopic surgery

Objective: To investigate the effects of epidural block anesthesia combined with general anesthesia on cognitive function and analgesic effect after thoracoscopic surgery. Methods: A randomized controlled study was conducted on 82 patients who underwent thoracoscopic surgery in the Affiliated Hospital of Nantong University from January 2018 to January 2019. Patients were divided into an observation group (n=41) and a control group (n=41) by random number method. The control group received general anesthesia, while the observation group also had epidural block anesthesia in addition to general anesthesia. Changes of heart rate (HR), mean arterial pressure (MAP) and blood oxygen saturation (SpO(2)) were compared between the two groups at different anesthesia time points. Intraoperative and postoperative indicators of both groups were recorded. Changes of serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) and high-sensitivity C-reactive protein (hs-CRP) before and after surgery were analyzed. At 1 h, 6 h, 24 h and 48 h after surgery, the changes of visual analogue scale (VAS) and mini-mental state examination (MMSE) were detected in both groups. At 6 h, 24 h, and 48 h after surgery, the incidence of postoperative cognitive dysfunction (POCD) and the need for analgesia of both groups were recorded and compared. Results: The dosages of propofol and remifentanil in the observation group were significantly lower than those in the control group (P<0.05). VAS and MMSE scores of the observation group were significantly better than those of the control group at 1 h, 6 h, 24 h and 48 h after surgery (P<0.05). Compared with the control group, the incidences of POCD in the observation group were significantly lower at 6 h, 24 h and 48 h after surgery, and the analgesia rates in the observation group were also significantly lower at 6 h-24 h and 24 h-48 h after surgery (P<0.05). There were no significant differences in IL-6, TNF-alpha and hs-CRP between the two groups before surgery (P>0.05); IL-6, TNF-alpha and hs-CRP levels in both groups were increased after surgery, and the levels in control group were significantly higher compared with observation group (P<0.05). Conclusion: The application of epidural block anesthesia combined with general anesthesia results in stable hemodynamics, improved analgesic effect, better incidence of POCD, and less inflammatory response, which is of high clinical value in thoracoscopic surgery.