Paediatric Surgery (Ukraine).2023.4(81): 59-65; doi: 10.15574/PS.2023.81.59
Svirhun M. V., Semenenko A. I.
National Pirogov Memorial Medical University, Vinnytsya, Ukraine

For citation: Svirhun MV, Semenenko AI. (2023). Analysis of the occurrence of postoperative cognitive dysfunction with the use of morphine hydrochloride after hip arthroplasty under spinal anesthesia. Paediatric Surgery (Ukraine). 4(81): 59-65; doi: 10.15574/PS.2023.81.59.
Article received: Sep 12, 2023. Accepted for publication: Dec 11, 2023.

Purpose – to analyze the state of cognitive function of patients according to the Mini Mental State Examination (MMSE) scale in points at different follow-up periods; to establish the relationship between the occurrence of postoperative cognitive dysfunction (POCD) and a single administration of morphine hydrochloride after hip arthroplasty under spinal anaesthesia in the early postoperative period
Materials and methods. The study was conducted on the basis of the Vinnytsia City Clinical Hospital of Emergency Medical Care with the participation of 120 patients. All patients were operated on for a hip fracture – hip joint replacement under spinal anesthesia. All patients in the postoperative period were evaluated for pain intensity according to the visual analog scale (VAS). In the early postoperative period, patients received: a combination of paracetamol and dexketoprofen. In case of insufficient effectiveness of paracetamol and dexketoprofen, which was assessed as the impossibility of maintaining the pain level according to VAS no more than 4 points, morphine hydrochloride 10 mg was used. The MMSE scale was used as one of the main evaluation scales for the dynamics of POCD. In this part of the work, patients were divided into two main groups depending on the dynamics of the cognitive deficit, which was determined by the MMSE scale during the entire period of observation, which generally divided the patients into two groups: «Without negative dynamics of cognitive functions» (n=85) and «With negative dynamics of cognitive functions» (n=35). Statistical processing was carried out using StatPlus programs according to parametric and non-parametric criteria, differences were considered significant at p<0.05.
Results. On the 7^th day after hip arthroplasty, the negative dynamics of cognitive function, compared to the data during hospitalization, remained in 68.6% of patients with morphine hydrochloride among them: in 41.6% of patients, mild cognitive disorders appeared in their absence at the stage of hospitalization, in 29.2% there was a transition from mild cognitive disorders to mild dementia and in another 29.2% – mild to moderate dementia (p=0.03).
Conclusions. The obtained data indicate that 92.3% of patients who had cognitive impairment at the time of discharge from the hospital received morphine hydrochloride, which may indicate a negative effect of the use of this drug on the cognitive functions of patients with hip arthroplasty on the background of a hip fracture.
The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research.
No conflict of interests was declared by the authors.
Keywords: morphine hydrochloride, postoperative cognitive dysfunction, hip joint replacement, spinal anesthesia.

REFERENCES

1. Awada HN, Luna IE, Kehlet H. (2019). Postoperative cognitive dysfunction is rare after fast-track hip- and knee arthroplasty – But potentially related to opioid use. J Clin Anesth. 57: 80-86. https://doi.org/10.1016/j.jclinane.2019.03.021; PMid:30927698

2. Besch G, Vettoretti L, Claveau M. (2018). Early post-operative cognitive dysfunction after closed-loop versus manual target controlled-infusion of propofol and remifentanil in patients undergoing elective major non-cardiac surgery: Protocol of the randomized controlled single-blind POCD-ELA trial. Medicine (Baltimore). 97(40): 125-158. https://doi.org/10.1097/MD.0000000000012558; PMid:30290615 PMCid:PMC6200461

3. Chi H, Kawano T, Tamura T. (2013). Postoperative pain impairs subsequent performance on a spatial memory task via effects on N-methyl-D-aspartate receptor in aged rats. Life Sci. 93(25-26): 986-993. https://doi.org/10.1016/j.lfs.2013.10.028; PMid:24211778

4. Colonna DM, Kilgus D, Brown W. (2002). Acute brain fat embolization occurring after total hip arthroplasty in the absence of a patent foramen ovale. Anesthesiology. 96(4): 1027-1029. https://doi.org/10.1097/00000542-200204000-00036; PMid:11964616

5. Czyż-Szypenbejl К, Mędrzycka-Dąbrowska W, Kwiecień-Jaguś K, Lewandowska K. (2019). The Occurrence of Postoperative Cognitive Dysfunction (POCD) – Systematic Review. Psychiatr Pol. 53(1): 145-160. https://doi.org/10.12740/PP/90648; PMid:31008471

6. Deo H, West G, Butcher C, Lewis P. (2011). The prevalence of cognitive dysfunction after conventional and computer-assisted total knee replacement. Knee. 18(2): 117-120. https://doi.org/10.1016/j.knee.2010.03.006; PMid:20615709

7. Ezhevskaya A, Prusakova Zh, Gostenko A, Belova A. (2017). Surgical stress response and cognitive dysfunction in spinal surgery: the role of epidural analgesia. Anesthesiology and resuscitation. 62(3): 185-190.

8. Gan J, Tu Q, Miao S. (2019). Effects of oxycodone applied for patient-controlled analgesia on postoperative cognitive function in elderly patients undergoing total hip arthroplasty: a randomized controlled clinical trial. Aging Clin Exp Res. 16: 405-420. https://doi.org/10.1007/s40520-019-01202-w; PMid:30993660

9. Gong GL, Liu B, Wu JX. (2018). Postoperative Cognitive Dysfunction Induced by Different Surgical Methods and Its Risk Factors. Am Surg. 84(9): 1531-1537. https://doi.org/10.1177/000313481808400963; PMid:30268189

10. Hebl JR, Kopp SL, Ali MH. (2005). A comprehensive anesthesia protocol that emphasizes peripheral nerve blockade for total knee and total hip arthroplasty. Journal of Bone and Joint Surgery. 87(12): 63-70. https://doi.org/10.2106/00004623-200511002-00008

11. Ivkin A, Grigoriev E, Shukevich D. (2018). Diagnosis of cognitive dysfunction in patients in intensive care units and intensive care units. Bulletin of anesthesiology and resuscitation. 15(3): 47-55. https://doi.org/10.21292/2078-5658-2018-15-3-47-55

12. Lejri I, Agapouda A, Grimm A, Eckert A. (2019). Mitochondria- and Oxidative Stress-Targeting Substances in Cognitive Decline-Related Disorders: From Molecular Mechanisms to Clinical Evidence. Oxid Med Cell Longev. 12: 409-412. https://doi.org/10.1155/2019/9695412; PMid:31214285 PMCid:PMC6535827

13. Locci A, Pinna G. (2017). Neurosteroid biosynthesis down-regulation and changes in GABAA receptor subunit composition: a biomarker axis in stress-induced cognitive and emotional impairment. Br J Pharmacol. 174(19): 3226-3241. https://doi.org/10.1111/bph.13843; PMid:28456011 PMCid:PMC5595768

14. Moller JT, Cluitmans P, Rasmussen LS. (1998). Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. Lancet. 351: 857-861. https://doi.org/10.1016/S0140-6736(97)07382-0; PMid:9525362

15. Ni С, Xu T, Li N. (2015). Cerebral oxygen saturation after multiple perioperative influential factors predicts the occurrence of postoperative cognitive dysfunction. BMC Anesthesiol. 15: 156-158. https://doi.org/10.1186/s12871-015-0117-6; PMid:26503361 PMCid:PMC4624171

16. Ruggiero C, Bonamassa L, Pelini L. (2017). Early post-surgical cognitive dysfunction is a risk factor for mortality among hip fracture hospitalized older persons. Osteoporos Int. 28(2): 667-675. https://doi.org/10.1007/s00198-016-3784-3; PMid:27717957

17. Scott JE, Mathias JL, Kneebone AC. (2014). Postoperative cognitive dysfunction after total joint arthroplasty in the elderly: a meta-analysis. Journal of Arthroplasty. 29(2): 261-267. https://doi.org/10.1016/j.arth.2013.06.007; PMid:23890520

18. Sharipova V, Valikhanov A. (2017). Postoperative cognitive dysfunction. Bulletin of emergency medicine. 10(1): 112-118.

19. Zhang J, Tian L, Zhang L. (2019). Relationship between white matter integrity and post-traumatic cognitive deficits: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 90(1): 98-107. https://doi.org/10.1136/jnnp-2017-317691; PMid:30072375