Comparison of the Effects of Epidural Anesthesia and General Anesthesia on Perioperative Cognitive Function and Deep Vein Thrombosis in Patients Undergoing Total Knee Arthroplasty

Abstract

Objective. To explore the effects of epidural anesthesia and general anesthesia on perioperative cognitive function and deep vein thrombosis (DVT) in patients undergoing total knee arthroplasty (TKA). Methods. Total of 68 patients undergoing TKA in our hospital from September 2019 to March 2021 were selected and divided into the control group under general anesthesia and the observation group under epidural anesthesia according to the different anesthesia methods, 34 patients in each group. TKA was selected in both groups and performed by the same group of physicians, anesthesiologists, and nursing staff. The mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation (SpO2) were observed immediately before anesthesia (T1), 30 min after anesthesia (T2), after surgery (T3), and 1 d after surgery (T4). The changes of platelet (PLC), fibrinogen (Fbg), prothrombin time (PT), activated partial thrombin time (APTT), and other coagulation indicators were recorded. The Montreal Cognitive Assessment (MoCA) scores before surgery and 1 d and 3 d after surgery were observed. The blood samples of the two groups were collected before surgery and 1 d and 3 d after surgery, and the levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) in the peripheral blood of the two groups were measured by ELISA. The number of postoperative mental disorders and DVT in the two groups was calculated. Results. The MAP and HR of T4 were lower than those of T1, T2, and T3. The MAP of T2, T3, and T4 in the observation group was lower than that in the control group ( $P<0.05$ ), and the SpO2 of T1–T4 in the two groups did not change significantly, and there was no significant difference between the two groups ( $P>0.05$ ). Compared with T1, there was no significant difference in PLC, Fbg, and PT in the observation group T4 ( $P>0.05$ ), and APTT was lower than T1 ( $P<0.05$ ). The PLC, PT, and APTT of T4 in the control group were all lower than those of T1 ( $P<0.05$ ), and there was no significant difference between Fbg and T1 ( $P>0.05$ ). The PLC, Fbg, and PT of T4 in the observation group were higher than those in the control group, while APTT was lower than that in the control group ( $P<0.05$ ). The MoCA scores of patients in both groups on the 1st and 3rd day after operation were lower than those before operation, and the observation group was higher than that in the control group ( $P<0.05$ ). The BDNF and NGF of patients in both groups were lower than those before operation on the 1st day after operation, and the BDNF and NGF in the observation group were higher than those in the control group on the 1st and 3rd day after operation ( $P<0.05$ ). The mental disorder (2.94%) and DVT incidence (2.94%) in the observation group were lower than those in the control group (29.41%, 26.47%) ( $P<0.05$ ). Conclusion. Epidural anesthesia for patients with TKA can obtain better clinical effects, maintain stable hemodynamic and coagulation states, reduce stress response of patients at the same time, and reduce perioperative cognitive dysfunction and the incidence of DVT in patients.