Minimizing Stress Response and Cognitive Dysfunction in Orthopedic Surgery: The Prospects of Epidural Anesthesia

Purpose: To evaluate the effect of epidural anesthesia on immune and inflammatory changes, and to indicate their possible correlation with cognitive functions in patients undergoing orthopedic surgery. Methods: Fifty-six female patients, aged 55-64 undergoing transpedicular fixations were randomly divided into two clinical groups: Group 1 (n = 31) where epidural and general anesthesia were combined and Group 2 (n = 25), in which general anesthesia with sevoflurane was administered. All the patients were assessed with the pain VAS at rest and during mobilization, and with the cognitive function standardized scales: MMSE, MoCA, and FAB. The plasma levels of cortisol, cytokines and were evaluated. Results: Group 1 patients have demonstrated more adequate pain relief, lower cortisol and cytokines levels. In Group 2, there were 32% of patients with transient and mild cognitive dysfunction on postoperative day (POD) 1 as compared with Group 1 (16%). All the cognitive impairments were gone by POD 5 after the surgery. Conclusion: Epidural anesthesia (EA) has proved to be the most adequate analgesia and yielded the highest total scores in the cognitive tests on POD 1, as compared with general sevoflurane anesthesia and postoperative opioid analgesia. EA can modulate adaptive immunity improving the distribution of white blood cells. However, further research is required to obtain more results regarding the pathogenesis of POCD in patients after spinal surgery.