• M J Jones, S E Piggott, R S Vaughan, A J Bayer, R G Newcombe, T C Twining, J Pathy, and M Rosen.
• University of Wales, College of Medicine, Cardiff.
• BMJ. 1990 Jun 30;300(6741):1683-7.

ObjectiveTo determine the influence of general or regional anaesthesia on long term mental function in elderly patients.DesignProspective study of patients randomly allocated to receive general or regional anaesthesia.SettingThe patients' homes and a large teaching hospital in Cardiff.Subjects146 Patients aged 60 and over scheduled for elective hip or knee replacement.Main Outcome MeasuresScores achieved in tests of cognitive function and functional competence.Results72 Patients were allocated to receive general anaesthesia and 74 regional anaesthesia. Anaesthetic technique did not influence the duration of the operation, time to mobilisation postoperatively, requirements for analgesia after the operation, or duration of stay in hospital. Three months after the operation there was an improvement in the score for the recognition component (76 ms, 95% confidence interval 9 to 144) and the response component (82 ms, 5 to 158) of the choice reaction time in the group receiving general anaesthesia compared with the group receiving regional anaesthesia. This was the only significant difference between the two groups in the assessments of cognitive and functional competence. Eleven patients receiving regional anaesthesia and 12 receiving general anaesthesia reported that their memory and concentration were worse than before the operation, but this was not confirmed by testing.ConclusionCognitive and functional competence in elderly patients was not detectably impaired after either general or regional anaesthesia when attention was paid to the known perioperative influences on mental function.

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