Effects of Gneneral Anesthesia Combined with Femoral Nerve Block on Postoperative Inflammatory Reaction and Cognitive Function in Elderly Patients after Total Knee Arthroplasty

GAO Jian-hua; WEI Zhi-hui

doi:10.3969/j.issn.1002-3429.2018.05.019

Abstract：Objective To investigate the effect of general anesthesia combined with femoral nerve block on postoperative cognitive function and inflammatory response in elderly patients after total knee arthroplasty(TKA). Methods A total of 67 elderly patients receiving TKA were randomly divided into two groups: general anesthesia group (n=32) and compound anesthesia group(n=35) according to random number table. The general anesthesia group received only general anesthesia, whereas the compound anesthesia group received femoral nerve block com-bined with general anesthesia. Anesthesia duration,bleeding volume,urine volume,fluid volume,monitoring value of bispectral index (BIS),Observer's assessment of alertness/sedation(OAA/S) scale,mini-mental state examina-tion (MMSE),interleukin (IL-6) and C reactive protein (CRP) of peripheral blood in two groups were observed and compared. Results The anesthesia duration in the compound anesthesia group was longer than that in general anesthesia group. The monitoring values of BIS at 10 min and 20 min after administration were all higher than those in the general anesthesia group. The scores of OAA/S at 5 min and 10 min after administration were all higher than those in general anesthesia group, and the difference was statistically significant (P<0.05). The MMSE score in general anesthesia group was significantly lower 24 and 48 h after operation,as compared with that before operation. The 24 h MMSE in compound anesthesia group was significantly lower than that before the operation,suggesting sig-nificant differences (P<0.05). The scores of 24 and 48 h MMSE in the compound anesthesia group were higher than those in the general anesthesia group,and there were significant differences(P<0.05). In general anesthesia group,serum IL-6 and CRP levels at 24 and 48 h after operation were remarkably higher than those before operation. The levels of 24 and 48 h serum IL 6 as well as 24 h CPR in compound anesthesia group were significantly higher than those before operation (P<0.05). The levels of serum IL-6 and CRP in 24 and 48 h after operation in com-pound anesthesia group were lower than those in the general anesthesia group,and significant differences were found (P<0.05). Conclusion Combined femoral nerve block can help to reduce the level of cognitive impairment and inflammatory factors in elderly patients under general anaesthesia after TAK.