Effect of regional anesthesia as a component of multimodal pain relief on the cognitive status of patients in ophthalmic surgery

This article examines and analyzes the dependence of the state of the central nervous system (CNS) in the postoperative period in patients who underwent penetrating keratoplasty.

MATERIAL AND METHODS: The analysis of cognitive status was performed using neuropsychological testing involving the scale of frontal dysfunctions (Frontal Assessment Battery–FAB) and a short scale for assessing mental status (Mini-Mental State Examination–MMSE). The results were assessed on the eve of the operation, 6 h after the operation, and 7 and 21 days after the operation. Depending on the applied method of anesthesia, several groups were identified. In group d, general anesthesia (OA) was used with dexmedetomidine infusion 40 min before surgery. In group b (before surgery), a wing-palatine fossa block was performed 20 min, in addition to general anesthesia. Anesthesia was maintained with sevoflurane–oxygen mixture at a low gas flow. The groups were statistically comparable in terms of age and gender. The depth of anesthesia and sedation was assessed using the bispectral index and analgesia nociception index, respectively.

RESULTS: According to the results of testing on the MMSE and FAB scales, the cognitive indicators in the first 6 h after surgery were higher in group d than in group b. However, by day 21, these indicators differed slightly (p < 0.05). Thus, the following tendencies were observed in group b 6 h after the operation: a decrease in indicators on the MMSE scale by 20.8% and on the FAB scale by 28.6% from the initial level. For group d, the indicators on the MMSE scale were reduced by 8.3%, and those on the FAB scale were reduced by 13.3% at the same stage of the study. When testing on the same scales 21 days after surgery, the indicators of cognitive functions were restored to the initial level in both groups.

CONCLUSION: The levels of cognitive functions of ophthalmic surgical patients after surgery involving regional anesthesia and dexmedetomidine differed significantly in the first hours of the postoperative period. After 21 days, the neuropsychological status did not differ significantly (p > 0.05).