Comparison of two patient-controlled analgesia techniques on neuropsychological functioning in the immediate postoperative period.
Pain may contribute to cognitive decline, which is a common complication in the early postoperative period. We compared the effects of two common pain management techniques, intravenous patient-controlled analgesia (PCA-IV) and patient-controlled epidural analgesia (PCEA), on cognitive functioning in the immediate postoperative period. Patients hospitalized for elective surgery were randomly assigned to one of the treatment groups (30 patients per group). A battery of objective, standardized neuropsychological tests was administered preoperatively and 24 hours after surgery. Pain intensity was also evaluated. Nonoperated volunteers served as controls. Patients of the PCA-IV group exhibited significantly higher pain scores than did patients of the PCEA group. PCA-IV patients exhibited significant deterioration in the postoperative period in all the neuropsychological measures, while the PCEA patients exhibited significant deterioration only in one cognitive index, compared to controls.
Beilin
Benzion
B
Department of Anesthesiology, Rabin Medical Center, Hasharon Hospital, Petah Tiqva, Israel.
Hoofien
Dan
D
Poran
Ravit
R
Gral
Inbal
I
Grinevich
Galina
G
Butin
Berta
B
Mayburd
Eduard
E
Shavit
Yehuda
Y
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D003071:Cognition / Q000187:drug effects*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011594:Psychometrics; D011930:Reaction Time / Q000187:drug effects
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D005283:Fentanyl; D002045:Bupivacaine