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SURGICAL STRESS RESPONSE AND COGNITIIVE DYSFUNCTION IN SPINAL SURGERY: THE ROLE OF EPIDURAL ANALGESIA


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Abstract

Objective. To evaluate the effect of epidural analgesia on postoperative pain, metabolic and immune changes, as well as the cognitive function of patients during the spine surgery. Methods. The study included 42 patients aged 45-60 underwent posterior pedicle fixation. They were divided into two groups: in group 1 (n = 24) patients were performed epidural and endotracheal anesthesia with sevoflurane, and then prolonged epidural analgesia with ropivacaine and fentanyl after surgery. In group 2 (n = 18) patients were performed general anesthesia with sevoflurane and fentanyl, followed by systemic administration of opioids after surgery. All patients were assessed with pain VAS at rest and during activation. Plasma levels of cortisol, cytokine, membrane markers on the surface of lymphocytes cells were evaluated during surgery and in the postoperative period. All patients were assessed four times with cognitive function standardized scales: MMSE, MoCA, and FAB. Results. The group 1 with epidural analgesia has shown the best results in pain relief. In comparison with the 2nd group patients in group 1 have had significantly lower plasma levels of cortisol, CRP, cytokines: IL 1β, IL-6, IL-10. In group 2 there were 33.3% of patients with transient temporary mild cognitive dysfunction on the POD 1, compared with group 1 (16,7%). All manifestations of POCD have been stopped by the fifth day after surgery. Conclusion. Epidural analgesia during the spine surgery can limit the inflammation and stress response, and provide the most adequate pain control and higher total score during the cognitive testing on the POD 1, compared with general anesthesia and opioids.


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