Effects of combined spinal-epidural anesthesia on cognitive function and serum NGF,BDNF levels in elderly patients undergoing lower limb fracture surgery

Peng Jun; Wang Run; Zhu Li; Qi Guiying; Jiang Dezhou; Liu Yan; Li Peng; Wu Yi

doi:10.11986/j.issn.1673-873X.2025.03.13

Abstract：Objective To investigate the effects of combined spinal-epidural anesthesia(CSEA)on cognitive function and ser-um nerve growth factor(NGF),brain-derived neurotrophic factor(BDNF)levels in elderly patients undergoing lower limb fracture surgery,aiming to provide references for clinical treatment.Methods Ninety-two elderly patients with lower limb fractures undergoing surgery at Chengdu Jinniu District People's Hospital from May 2022 to March 2024 were selected as the study participants.Patients were assigned to a combined group(n=46)and a control group(n=46)using a random number table.The control group received general anesthesia,while the combined group received CSEA.Operation time,in-traoperative blood loss,time to ambulation,mean arterial pressure(MAP),heart rate(HR),Mini-Mental State Examina-tion(MMSE)scores,Visual Analogue Scale(VAS)scores,and serum NGF and BDNF levels at different time points were compared between the two groups.Results No statistically significant differences were observed in operation time,intraop-erative blood loss,or time to ambulation between the two groups(P>0.05).Compared with pre-anesthesia,MAP and HR decreased at the beginning of surgery and at the end of surgery in both the combined and control groups;the decreases in MAP and HR were smaller in the combined group than in the control group,with statistically significant differences(P<0.05).Compared with preoperative values,MMSE scores decreased at 24 hours and 7 days postoperatively in both groups;the decrease in MMSE scores was smaller in the combined group than in the control group,with statistically significant differences(P<0.05).Preoperatively,no statistically significant difference was noted in serum NGF or BDNF levels be-tween the two groups(P>0.05);compared with preoperative values,serum NGF and BDNF levels decreased significantly at 24 hours postoperatively in both the combined and control groups,with significantly smaller decreases in the combined group than in the control group(P<0.05).VAS scores at 6 hours,12 hours,and 24 hours postoperatively were signifi-cantly lower in the combined group than in the control group(P<0.05).Conclusion CSEA demonstrates favorable appli-cation outcomes in elderly patients with lower limb fractures.It not only reduces the risk of postoperative cognitive impair-ment and alleviates postoperative pain but also helps maintain intraoperative hemodynamic stability,with marked clinical effects,holding promise for clinical promotion.