Regular Research ArticlesThe Effects of Postoperative Pain and Its Management on Postoperative Cognitive Dysfunction
Section snippets
Patient Recruitment
Patients included in this study are a subset from a larger ongoing study evaluating the effect of type of anesthesia on perioperative outcomes in elderly surgical patients (Table 1). The sample consisted of nondelirious patients who underwent noncardiac surgery. The study was conducted from 2001–2004 at one of the teaching hospitals at the University of California, San Francisco (UCSF). The study received approval from the Institutional Review Board for human research at UCSF and Purdue
RESULTS
The 225 nondelirious patients included in this study had a mean age of 72.4 ± 7.6 years, 86% were white, 43% were female, and 21% received no greater than high school education. Approximately 26% patients underwent hip and knee replacement surgery, 22% other orthopedic surgery (nonintracranial, surgery of the spine), followed by urologic (21%), gynecologic (9%), or vascular (9%) surgery. Preoperatively, 46% of patients were classified as ASA class ≥3, and 67% were independent in all seven
DISCUSSION
This study revealed that patients who receive postoperative analgesia orally are significantly less likely to experience POCD. Prior studies revealed that POCD is associated with declines in daily functioning three months after surgery,4, 5, 6, 7, 8, 9, 10, 11, 12, 13 so it is important to identify treatment factors that increase a patient's risk for experiencing POCD. Although prior studies have identified risks for POCD4, 12, 13, 14, 15, 17, 39 they have not focused on whether postoperative
CONCLUSIONS
Fifteen percent of nondelirious older patients undergoing noncardiac surgery experienced POCD. Compared with other forms of postoperative analgesia methods, patients using oral analgesics to control postoperative pain were at significantly lower risk for experiencing POCD.
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Supported by NIH grants AG-022090 and K24 AG00948 to L. Sands and J. Leung, respectively.