Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain Management1993-65082687-1394Eco-Vector7594610.17816/RA75946Research ArticleEffect of regional anesthesia as a component of multimodal pain relief on the cognitive status of patients in ophthalmic surgeryDorofeevaGanna S.<p>post-graduate student</p>das1977@rambler.ruhttps://orcid.org/0000-0001-8418-3243KobelyatskyyYuriy Yu.<p>MD, PhD, Professor</p>kobeliatsky@ukr.nethttps://orcid.org/0000-0002-8504-6125Dnepropetrovsk Regional Clinical Ophthalmologic HospitalDnepropetrovsk Medical Academy1501202115149560907202109072021Copyright © 2021, Eco-Vector2021<p>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.</p>
<p><strong><em>MATERIAL AND METHODS:</em></strong> The analysis of cognitive status was performed using neuropsychological testing involving the scale of frontal dysfunctions (Frontal Assessment BatteryFAB) and a short scale for assessing mental status (Mini-Mental State ExaminationMMSE). 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 sevofluraneoxygen 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.</p>
<p><strong><em>RESULTS:</em></strong> 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.</p>
<p><strong><em>CONCLUSION</em></strong><strong><em>:</em></strong> 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 (<em>p</em> 0.05).</p>postoperative cognitive dysfunctionscale MMSEFABpterygopalatine fossa blockdexmedetomidineпослеоперационная когнитивная дисфункцияшкала MMSEFABблокада крылонёбной ямкидексмедетомидин[Brown EN, Pavone KJ, Naranjo M. Multimodal General Anesthesia: Theory and Practice. Anesth Analg. 2018;127(5):1246-1258. doi: 10.1213/ANE.0000000000003668][Smith CR, Helander E, Chheda NN. Trigeminal Nerve Blockade in the Pterygopalatine Fossa for the Management of Postoperative Pain in Three Adults Undergoing Tonsillectomy: A Proof-of-Concept Report. Pain Medicine. 2020;21(10):2441-2446. doi: 10.1093/pm/pnaa062][Kotekar N, Shenkar A, Nagaraj R. Postoperative cognitive dysfunction - current preventive strategies. Clin Interv Aging. 2018;13:2267-2273. doi: 10.2147/CIA.S133896][Akimenko TI, Zhenilo VM, Zdiruk SV, Aleksandrovich YS. Reduction in the incidence of postoperative cognitive impairment after hysterectomy with inhalational sevoflurane anesthesia. Almanac of clinical medicine. 2018;46(7):699-707. (In Russ).][Varin M, Kergoat MJ, Belleville S, et al. Age-Related Eye Disease and Cognitive Function: The Search for Mediators. Ophthalmology. 2020;127(5):660-666. doi: 10.1016/j.ophtha.2019.10.004][De Oliveira GS, Jr., Almeida MD, Benzon HT, McCarthy RJ. Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. 2011;115(3):575-588. doi: 10.1097/ALN.0b013e31822a24c2][Lee DG. Idea on prevention from postoperative intraorbital hematoma in orbital surgery. Indian J Otolaryngol Head Neck Surg. 2014;66(Suppl 1):323-325. doi: 10.1007/s12070-011-0449-6][Krishtafor AA, Iovenko IА, Chernenko VG, et al. Peculiarities of cognitive impairment in patients wounded in action. Emergency Medicine. 2017;0(2.81):110-116. doi: 10.22141/2224-0586.2.81.2017.99701 (In Russ).][Ayvardgi AA, Kobeliatskyy YY. ANI-monitoring in assessing the effectiveness of the anesthetic management for plastic surgery of the nose. Emergency Medicine. 2018;0(1.88):103-107. doi: 10.22141/2224-0586.1.88.2018.124975][Shchuko AG, Iureva TN, Oleshchenko IG. Role of pterygopalatine blockade in the early rehabilitation program of children after congenital cataract surgery. Ophthalmology journal. 2017;10(4):18-23. doi: 10.17816/ov10418-23 (In Russ).][Antonomonov MY. Mathematical processing and analysis of biomedical data. Kiev: Medinform; 2017. (In Russ).]