Table 2.
Studies comparing the incidence of POCD with general versus regional anesthesia
| Study | Year | Study group | Age (years)* | General anesthesia | Regional anesthesia | Cognitive variables evaluated | Assessment time | Difference found? | Time point of latest significant difference | Time point of earliest similar incidence | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Medications used | Number of patients | Technique | Medications used | Number of patients | |||||||||
| Prospective randomized controlled studies | |||||||||||||
| Jones et al. [24] | 1990 | TKA, THA | NR (60+) | Diazepam, thiopental, pancuronium, N2O, halothane, fentanyl | 72 | Spinal | Bupivicaine, midazolam | 74 | Neuropsychologic tests | 3 months | No | 3 months | |
| Prospective randomized studies | |||||||||||||
| Anwer et al. [3] | 2006 | Noncardiac major surgery | 62 (60–64) | Midazolam, thiopental, halothane, N2O | 30 | Spinal or epidural | Bupivicaine or lidocaine; midazolam | 30 | WAIS-R | Preop 1 day 3 days | Yes | 3 days (greater POCD in GA) | |
| Kudoh et al. [26] | 2004 | TKA | 75 (NR) | Fentanyl, propofol, vecuroniom | 75 | Spinal + LMA | Bupivicaine; propofol | 75 | Confusion (CAM) | POD 1, 2, 3, 4 | Yes | 1 day (greater POCD in GA) | 2 days |
| Rasmussen et al. [38] | 2003 | Noncardiac major surgery | 71 (61–84) | Variable | 217 | Spinal or epidural | Variable | 211 | Neuropsychologic tests | Preop 7 days 3 months | Yes | 7 days (greater POCD in GA) | 3 months |
| Williams-Russo et al. [45] | 1995 | TKA | 69 (NR) | Thiopental, fentanyl, vecuronium, isflurane, N2O | 128 | Epidural | Lidocaine or bupivicaine, midazolam, fentanyl | 134 | Neuropsychologic tests Clinical delirium | Preop 1 week 6 months | No | 1 week | |
| Nielson et al. [35] | 1990 | TKA | 60–86 | Thiopental, succinylcholine, N2O, isoflurane, fentanyl | 39 | Spinal | Tetracaine or bupivicaine | 25 | WAIS Wechsler Memory Scale Neuropsychologic tests Sickness Impact Profile |
Preop 3 months | No | 3 months | |
| Ghoneim et al. [14] | 1988 | Noncardiac major surgery | 61 (25–86) | Diazepam, thiopental, isoflurane or enflurane, N2O; variable use of fentanyl | 53 | Spinal (38), epidural (14) | Tetracaine (spinal) or bupivicaine (epidural); variable use of diazepam, midazolam, fentanyl | 52 | Neuropsychologic tests | Preop 1st outpatient visit 3 months | No | 1st outpatient followup | |
| Prospective comparative studies | |||||||||||||
| Rodriguez et al. [41] | 2005 | TKA | 69 (45–82) | Fentanyl, midazolam, propofol, atracurium, sufentanil, sevoflurane, N2O | 12 | Spinal | Midazolam; neuraxial agent NR | 25 | Neuropsychologic tests | Preop 1 week 3 months | No | 1 week | |
| Ancelin et al. [2] | 2001 | Orthopaedic elective | 73 (64–87) | Variable | 52 | Regional (variable) | Variable | 88 | Neuropsychologic tests | Preop 9 days 3 months | No | ||
* Values are expressed as mean, with range in parentheses; POCD = postoperative cognitive dysfunction; NR = not reported; N2O = nitrous oxide; LMA = laryngeal mask airway; WAIS-R = Weschler Adult Intelligence Scale, revised form; CAM = Confusion Assessment Method; WAIS = Weschler Adult Intelligence Scale; preop = preoperatively; POD = postoperative day; GA = general anesthesia.