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Effects of general anesthesia and epidural anesthesia on deep vein thrombosis and perioperative cognitive function of patients undergoing total knee arthroplasty.

OBJECTIVE
To explore the effects of general anesthesia and epidural anesthesia on deep vein thrombosis (DVT) and perioperative cognitive function of patients undergoing total knee arthroplasty.


METHODS
A retrospective analysis was conducted on 110 orthopedic patients who underwent total knee arthroplasty at Zhangzhou Affiliated Hospital of Fujian Medical University from March 2018 to March 2021. According to different anesthesia schemes, 56 cases with epidural anesthesia were included in the observation group and 54 patients with general anesthesia were assigned to the control group. The following items were recorded and compared between the two groups: postoperative coagulation indicators; operation duration, total dosage of anesthetics; postoperative recovery time; heart rate (HR) and mean arterial pressure (MAP) before anesthesia induction (T0), intubation (T1), and completion of the operation (T2); cognitive function before surgery and 1 d and 3 d after surgery; postoperative incidence of DVT; pain at postoperative 24 h; stress-related factors before and 2 h after surgery, and incidence of adverse reactions during hospitalization.


RESULTS
Compared to the control group, the levels of fibrinogen (Fbg) and platelets (PLC) in the observation group 24 hours after surgery were significantly lower, with longer thrombin time (TT) and prothrombin time (PT) (all P<0.05); no significant difference was found in operation duration between the two groups (P>0.05). Total dosage of anesthetics and postoperative recovery time were less in the observation group (P<0.05); the HR and MAP fluctuations were lower in the observation group (P<0.05). The postoperative cognitive function score of patients in the observation group was significantly higher (P<0.05), with a lower incidence of postoperative DVT (P<0.05) and better relief of pain (P<0.05). The expression levels of stress-related factors 2 h after surgery and the incidence of adverse reactions were lower in the observation group compared to the control group (P<0.05).


CONCLUSION
In total knee arthroplasty, epidural anesthesia, compared with general anesthesia, can reduce the incidence of DVT in patients and has less impact on patients' cognitive function and stress state with a higher safety profile.