Comparison of two patient-controlled analgesia techniques on neuropsychological functioning in the immediate postoperative period

Abstract

Pain may contribute to cognitive decline, which is a common complication in the early postoperative period. We compared the effects of two common pain management techniques, intravenous patient-controlled analgesia (PCA-IV) and patient-controlled epidural analgesia (PCEA), on cognitive functioning in the immediate postoperative period. Patients hospitalized for elective surgery were randomly assigned to one of the treatment groups (30 patients per group). A battery of objective, standardized neuropsychological tests was administered preoperatively and 24 hours after surgery. Pain intensity was also evaluated. Nonoperated volunteers served as controls. Patients of the PCA-IV group exhibited significantly higher pain scores than did patients of the PCEA group. PCA-IV patients exhibited significant deterioration in the postoperative period in all the neuropsychological measures, while the PCEA patients exhibited significant deterioration only in one cognitive index, compared to controls.

Keywords:

• Cognitive function
• Local anaesthetics
• Opiates
• PCA-IV
• PCEA
• Postoperative pain

This study was supported solely by department sources and was facilitated by the Leon and Clara Sznajderman Chair of Psychology (YS). The Rabin Medical Center, Hasharon Hospital, Petah Tiqva, Israel, is affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Ravit Poran and Inbal Gral made equal contribution to this study.