The association of cognitive dysfunction with CRP, cortisol, insulin, glucose and administered anesthesia type in total knee arthroplasties

ISRCTN	ISRCTN67177877
DOI	https://doi.org/10.1186/ISRCTN67177877
Secondary identifying numbers	2017-01/01

Submission date: 11/11/2017
Registration date: 16/11/2017
Last edited: 15/11/2017

Recruitment status: No longer recruiting
Overall study status: Completed
Condition category: Mental and Behavioural Disorders

Prospectively registered

Protocol

Statistical analysis plan

Results

Individual participant data

Record updated in last year

Plain English summary of protocol

Background and study aims
Total knee arhtroplasty (TKA) or total knee replacements are a surgical procedure that replaces parts of the knee with metal and plastic joins. With the increasing age of the population, the amount of TKA has increased considerably. TKA is a very effective surgery for patients because they have favorable surgical outcomes as they noticeably lessen pain and enhances physical function. But like all operations, TKA have their own complications like thromboembolism (blood clots that forms and can plug the lungs, brains, kidneys, etc), cardiac arrhythmia (irregular heartbeat), pneumonia (inflammation of the lungs), pain, delirium (confusion) and postoperative cognitive dysfunction (POCD). POCD is one of the most important problems occurring after the TKA operation. POCD disturbs cognitive (mental) function, like, memory, attention, orientation, and concentration. There is research that says increases in hospital stay can cause functional damage, morbidity (diseases and illness), diminish in quality of life significantly. The exact causes behind the development of POCD are uncertain. The incidence of complications associated with TKA can vary with the type of anesthesia used in the surgery, such as general anesthesia that causes the patient to be unconscious and regional anesthesia that numbs a part of the body only. There have been conflicting results in terms of the effect of the anesthesia technique and POCD. The aim of this study is to investigate if the the amount of POCD changes with the type of anesthetic technique used.

Who can participate?
Adults aged 18-90 years old who are scheduled to undergo TKA.

What does the study involve?
Participants complete a questionnaire a day before their surgery. Participants are then randomly allocated to one of two groups. Participants in the first group receive the general anesthesia and then receive the surgery. Participants in the second group receive regional anesthesia that numbs a certain part of the body but does not make the person unconscious. Participants provide blood samples 15 before anesthesia, and at three and 24 hours after their surgeries. Participants repeat the questionnaire seven and 30 days after the procedure.

What are the possible benefits and risks of participating?
There are no direct benefits. There will be no additional risks to our patients because the anaesthetic techniques we apply are routine interventions for anaesthesia. There may be some mild discomfort when providing blood samples. The interviews with the patients are short and are harmless to the patients.

Where is the study run from?
Ahi Evran University, AEU (Turkey)

When is the study starting and how long is it expected to run for?
December 2016 to October 2017

Who is funding the study?
Ahi Evran University, AEU (Turkey)

Who is the main contact?
Dr Ipek Saadet Edipoglu

Contact information

Dr Ipek Saadet Edipoglu
Scientific

Department of Anesthesiology
Suleymaniye Obstetrics & Pediatrics Training and Research Hospital
Istanbul
34020
Türkiye

ORCID ID	0000-0002-3510-5991

Study information

Study design	Single center randomised interventional study
Primary study design	Interventional
Secondary study design	Randomised parallel trial
Study setting(s)	Hospital
Study type	Diagnostic
Participant information sheet	Not available in web format, please use the contact details below to request a patient information sheet
Scientific title	The association of cognitive disfunction with crp, cortisol, insulin, glucose and administered anesthesia type in total knee arthroplasties: A randomised controlled trial
Study objectives	The aim of this study is to investigate if the incidence of postoperative cognitive dysfunction changes according to the anesthetic technique preferred (general or regional). The secondary study aim is to detect the association of the biomarkers of surgical stress (CRP, insulin, cortisol) and anesthetic technique applied (general or regional).
Ethics approval(s)	Ahi Evran University ethical committee, 03/01/2017, ref: 2017-01/01
Health condition(s) or problem(s) studied	Postoperative cognitive dysfunction
Intervention	Participants are randomised with computer software program for block randomization and divided into general or regional anesthesia group. If a patient had a contradiction for their anesthesia type randomized, they are excluded from the study. The participants in each group differ in terms of the anaesthetic technique they got. General anesthesia affects the entire body and makes the person unconscious. The unconscious person is completely unaware of what is going on and does not feel pain from the surgery or procedure. Our general anesteshia group patients have hypnotics (Propofol) and opioids (fentanyl) and muscle relaxants (rocuronium) for their induction of anesthesia. Regional anesthesia numbs a limited part of the body and prevents patients from feeling pain and does not make the person unconscious. Our regional anesthesia patients have 15 mg of spinal heavy bupivacaine in their intrathecal space. Routine general anesthesia induction for TKA involved using 100% oxygen, followed by an induction with Propofol (2 mg kg-1) and rocuronium (0.6 mg kg-1). Anesthesia was maintained with sevoflurane (2%) and a mix of 50% O2 and 50% nitrous oxide. Routine regional anesthesia administration involved a single shot of 2.8 ml hyperbaric bupivacaine (0.5%) into the subarachnoid space of the L3-L4 intervertebral space. All patients had same pain treatment with morphine patient controlled analgesia (PCA). Rescue pain treatment is used with tramadol and additional morphine when necessary. Blood samples from all participants are included in the study. Cortisol, insulin, CRP and blood glucose levels are tested. Blood samples are taken 15 minutes before anesthesia induction for base results, intraoperative 1th hour, postoperative 3rd hour and postoperative 24th hour. The neurocognitive tests are achieved by one of our anesthesiology consultant who were under the supervision of a psychiatrist. Mini mental test (MMS), The Cognitive Failure Questionnaire (CFQ), Auditory Verbal Learning Test (AVLT) and Stroop Interference Test (SIT) are applied by anesthetist one-day before operation (preoperative), seven-days after operation and 30-days after operation. All participants have the same follow up. In the first postoperative day they have the same analgesic treatments (Patient controlled analgesia-PCA). They are assessed 7-days after and 30-days after with questionnaires. No additional intervention or follow up is required.
Intervention type	Procedure/Surgery
Primary outcome measure	Incidence of postoperative cognitive dysfunction changes is measured using the Mini mental test (MMS), The Cognitive Failure Questionnaire (CFQ), Auditory Verbal Learning Test (AVLT) and Stroop Interference Test (SIT) at 1st preoperative, 7th and 30th postoperative days.
Secondary outcome measures	The association of the biomarkers of surgical stress (CRP, insulin, cortisol glucose) and anesthetic technique applied (general or regional) is measured using routine kits at before 15 minutes before anesthesia induction (preoperative), 1st hour during operation, 3rd and 24th hours after operation.
Overall study start date	03/12/2016
Completion date	04/10/2017

Eligibility

Participant type(s)	Patient
Age group	Adult
Sex	Both
Target number of participants	80
Key inclusion criteria	1. Patients scheduled for elective total knee arthroplasty (TKA) 2. Aged <90 3. BMI<40 4. Patients with a Mini Mental Score>15 5. Unilateral cases
Key exclusion criteria	1. Patients >90 2. Emergent cases 3. Patients with prior psychiatric or neurologic disorders 4. Patients using steroid medications 5. Uncontrolled diabetes
Date of first enrolment	04/01/2017
Date of final enrolment	05/09/2017

Locations

Countries of recruitment

Türkiye

Study participating centre

Ahi Evran University

Istanbul
40100
Türkiye

Sponsor information

Ahi Evran University Medical Faculty
Hospital/treatment centre

Bağbaşı Mahallesi
Şht. Sahir Kurutluoğlu Cd.
Kırsehir
40100
Türkiye

"ROR"	https://ror.org/05rrfpt58

Funders

Funder type

University/education

Ahi Evran Üniversitesi
Private sector organisation / Universities (academic only)

Alternative name(s): Ahi Evran University, AEU
Location: Türkiye

Results and Publications

Intention to publish date	01/10/2018
Individual participant data (IPD) Intention to share	Yes
IPD sharing plan summary	Available on request
Publication and dissemination plan	We planned publication in a high-impact peer reviewed journal.
IPD sharing plan	The datasets generated during and/or analysed during the current study are/will be available upon request from Dr. Ipek S. Edipoglu. dripeks@yahoo.com.