ABSTRACT

To investigate the effects of thoracic epidural analgesia on postope-rative cognitive functions after thoracic surgery.

Thirty patients were included in this study after et-hics committee approval was obtained. The patients were divided into two gro-ups: those that received thoracal epidural analgesia (group E) and those that re-ceived remifentanyl analgesia (group R). All patients underwent a preoperati-ve mini-mental test (MMT) in their hospital rooms before the operation and the same test was performed again on postoperative days 1 and 7 by the same anesthetist. Before anesthesia induction epidural catheterization was performed on thoracal 4-5 or 5-6 level and a 3 ml test dose (60 mg lidocaine + 15 μg epinephrine) was applied to all patients. After the test dose, in group E 7 ml 0.25% isobaric bupivacaine bolus and then 5 ml/hour 0.25% isobaric bupiva-caine infusion were started via an epidural catheter. No medication was appli-ed to group Rafter the test dose via epidural catheter. Anesthesia was induced using thiopentone and pancuronyum. After double lumen tube intubation anest-hesia was maintained with isoflurane (according to BIS value) in an oxygen-air mixture and only in group R 0.2 μg kg-1 min-1 remifentanyl was used during the operation applied via intravenous infusion. Bolus 7 ml isobaric bupivacai-ne (0.25%) was applied via an epidural catheter during skin saturation in gro-up R. At the end of the operation the muscle relaxant was reversed and the pa-tients were extubated. Epidural morphine was used for postoperative analge-sia in both groups.

In group R MMT-orientation day 7 scores were lower than their pre-operative values and group E scores. MMT-recall day 7 scores were lower in group R than in group E. In group R MMT-language day 1 scores were lower than their preoperative and group E scores but day 7 scores were lower than group E day 7 scores. In both groups total MMT day 1 scores were lower than their preoperative scores, but, while day 7 group R scores were lower than their preoperative scores, group E scores returned to preoperative values.

Thoracic epidural analgesia combined with general anesthesia improves postoperative cognitive functions after thoracic surgery