Impact of Dexmedetomidine Supplemented Analgesia on Delirium in Patients Recovering From Orthopedic Surgery

A Randomized Controlled Trial

Hong Hong; Da-Zhi Zhang; Mo Li; Geng Wang; Sai-Nan Zhu; Yue Zhang; Dong-Xin Wang; Daniel I. Sessler

Disclosures

BMC Anesthesiol. 2021;21(223) 

In This Article

Background

Because the population is aging, the demand for orthopedic surgery is increasing, especially among the elderly. Delirium is common amongst elderly patients recovering from major orthopedic surgery. The reported incidence ranges from 5 to 14% after total joint arthroplasty,[1] from 0.5 to 24% after spinal surgery,[2] and from 12 to 56% after hip fracture surgery.[3] Patients who experience postoperative delirium have worse outcomes including prolonged hospitalization, increased costs, lower odds of home discharge, more readmissions, delayed functional recovery, and increased perioperative and long-term mortality.[4,5] While delirium is now recognized as a serious complication, there is so far no convincing evidence that any preventive strategy is effective.[6]

Postoperative delirium is probably facilitated by multiple factors which may include severe pain,[7] opioid medication,[8] sleep disturbances,[9] and the stress response and inflammation consequent to surgical tissue injury.[10] Dexmedetomidine is a highly selective alpha-2-adrenergic agonist with sedative, analgesic, and anxiolytic properties. For postoperative patients, low-dose dexmedetomidine infusion promoted normal sleep architecture by increasing total and stage 2 non-rapid eye movement sleep but not rapid eye movement sleep.[11] When used in combination with opioids after surgery, it improves analgesia and sleep quality while reducing opioid consumption.[12,13] Dexmedetomidine also attenuates the surgical stress response and consequent inflammation.[14] These characteristics make dexmedetomidine a potential candidate for delirium prevention. Indeed, when used during anesthesia or in the intensive care unit, dexmedetomidine reportedly reduces postoperative delirium.[15]

We therefore tested the primary hypothesis that supplementing intravenous analgesia with dexmedetomidine reduces delirium in elderly patients recovering from major orthopedic surgery. Secondarily, we tested the hypotheses that dexmedetomidine supplementation improves postoperative analgesia and subjective sleep quality.

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