Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery

Abstract Background Postoperative delirium (POD) is a common complication of older people undergoing hip fracture surgery, which negatively affects clinical- and healthcare-related outcomes. Unfortunately, POD pathophysiology is still largely unknown, despite previous studies showing that neuroinflammation, neuroendocrine dysfunction, increased reactive oxidative stress (ROS), and endothelial dysfunctions may be involved. There is also evidence that many of the pathophysiological mechanisms which are involved in delirium are involved in sarcopenia too. This article describes the protocol of a pilot study to evaluate the feasibility of a larger one that will explore the pathophysiological mechanisms correlating POD with sarcopenia. We will analyse whether various biomarkers reflecting neuroinflammation, ROS, neuroendocrine disorders, and microvasculature lesions will be simultaneously expressed in in the blood, cerebrospinal fluid (CSF), and muscles of patients developing POD. Methods Two centres will be involved in this study, each recruiting a convenient sample of ten older patients with hip fracture. All of them will undergo a baseline Comprehensive Geriatric Assessment, which will be used to construct a Rockwood-based Frailty Index (FI). Blood samples will be collected for each patient on the day of surgery and 1 day before. Additionally, CSF and muscle fragments will be taken and given to a biologist for subsequent analyses. The presence of POD will be assessed in each patient every morning until hospital discharge using the 4AT. Delirium subtypes and severity will be assessed using the Delirium Motor Subtype Scale-4 and the Delirium-O-Meter, respectively. We will also evaluate the patient’s functional status at discharge, using the Cumulated Ambulation Score. Discussion This study will be the first to correlate biomarkers of blood, CSF, and muscle in older patients with hip fracture.

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Comparison of regional with general anaesthesia on postoperative delirium (RAGA-delirium) in the older patients undergoing hip fracture surgery: study protocol for a multicentre randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2017-016937 ◽

2017 ◽

Vol 7 (10) ◽

pp. e016937 ◽

Cited By ~ 11

Author(s):

Ting Li ◽

Joyce Yeung ◽

Jun Li ◽

Yan Zhang ◽

Teresa Melody ◽

...

Keyword(s):

Clinical Trial ◽

Hip Fracture ◽

General Anaesthesia ◽

Older Patients ◽

Postoperative Delirium ◽

Controlled Trial ◽

Controlled Clinical Trial ◽

Hip Fracture Surgery ◽

Randomised Controlled ◽

Fracture Surgery

IntroductionPostoperative delirium (POD) is a common serious postoperative complication especially in older people and is associated with increased mortality, morbidity and healthcare costs. There is no clear consensus which anaesthesia is associated with less incidence of POD for older patients. We aim to assess whether regional anaesthesia results in lower incidence of POD comparing with general anaesthesia (GA) among older patients undergoing hip fracture surgery.Methods and analysisRAGA-delirium is a pragmatic, multicentre, prospective, parallel grouped, randomised controlled clinical trial comparing RA or GA for hip fracture surgery. A total of 1000 patients who are 65 years or over and who are having planned hip fracture surgery in nine clinical trial centres of China will be randomised in a 1:1 ratio to receive either anaesthesia for the surgery. The primary endpoint will be the incidence of POD at day 7. The secondary endpoints will be the subtype, severity and duration of delirium, postoperative acute pain score, incidence of other postoperative non-delirium complications, quality of life and cost-effective outcomes. Randomisation will be performed at the patient level using computer-generated assignment. Outcome assessors will be blinded from intervention assignment. Assessments will be conducted before surgery, intraoperatively, postoperatively, during the hospital stay, at 30-day, 6-month and 1-year postoperative intervals.Potential impact of studyThis study will provide clinical evidence with a more robust methodology to help anaesthetists in selecting appropriate anaesthesia for older patients with high risk for POD. At the era of increasing emphasis on delirium prevention, this trial has the potential to inform the future national guideline to reduce POD.Ethics and disseminationEthical approved by the local institutional review board. Trial results will be presented at national and international academic conferences, and published in peer-reviewed journals.Trial registration numberClinicalTrials.gov (NCT02213380); pre-results.

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Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study

BioMed Research International ◽

10.1155/2016/1054597 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Chung-Sik Oh ◽

Ka Young Rhee ◽

Tae-Gyoon Yoon ◽

Nam-Sik Woo ◽

Seung Wan Hong ◽

...

Keyword(s):

Hip Fracture ◽

Elderly Patients ◽

General Anesthesia ◽

Cholinesterase Inhibitor ◽

Postoperative Delirium ◽

Neuromuscular Block ◽

Pulmonary Complications ◽

Laboratory Findings ◽

Hip Fracture Surgery ◽

Fracture Surgery

Background.Residual neuromuscular block (NMB) after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD). We evaluated the effects of sugammadex on POD in elderly patients who underwent hip fracture surgery.Methods.Medical records of 174 consecutive patients who underwent hip fracture surgery with general anesthesia were reviewed retrospectively to compare the perioperative incidence of POD, pulmonary complications, time to extubation, incidence of hypoxia, and laboratory findings between patients treated with sugammadex and those treated with a conventional cholinesterase inhibitor.Results.The incidence of POD was not significantly different between the two groups (33.3% versus 36.5%, resp.;P=0.750). Postoperative pulmonary complications and laboratory findings did not showed significant intergroup difference. However, time to extubation (6 ± 3 versus 8 ± 3 min;P<0.001) and the frequency of postoperative hypoxia were significantly lower (23% versus 43%;P=0.010) in the sugammadex group than in the conventional cholinesterase inhibitor group.Conclusion.Sugammadex did not reduce POD or pulmonary complications compared to conventional cholinesterase inhibitors, despite reducing time to extubation and postoperative hypoxia in elderly patients who underwent hip fracture surgery under general anesthesia.

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The Hip Fracture Surgery in Elderly Patients (HIPELD) study: protocol for a randomized, multicenter controlled trial evaluating the effect of xenon on postoperative delirium in older patients undergoing hip fracture surgery

Trials ◽

10.1186/1745-6215-13-180 ◽

2012 ◽

Vol 13 (1) ◽

Cited By ~ 12

Author(s):

Mark Coburn ◽

Robert D Sanders ◽

Mervyn Maze ◽

Rolf Rossaint

Keyword(s):

Hip Fracture ◽

Elderly Patients ◽

Study Protocol ◽

Older Patients ◽

Postoperative Delirium ◽

Controlled Trial ◽

Hip Fracture Surgery ◽

Fracture Surgery ◽

Surgery In Elderly

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Comparison of Effects between Combined Lumbar-Sacral Plexus Block plus General Anesthesia and Unilateral Spinal Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery: A Pilot Randomized Controlled Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/6685497 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Lili Tang ◽

Panpan Fang ◽

Yuxin Fang ◽

Yao Lu ◽

Guanghong Xu ◽

...

Keyword(s):

Hip Fracture ◽

Elderly Patients ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Postoperative Delirium ◽

Sacral Plexus ◽

Hip Fracture Surgery ◽

Unilateral Spinal Anesthesia ◽

Plexus Block ◽

Fracture Surgery

Purpose. Hip fracture is a common injury in geriatric populations, which is associated with poor quality of life. However, the ideal anesthesia technique for this disease is yet to be identified. This study aimed to compare the combined lumbar-sacral plexus block (CLSB) plus general anesthesia (bispectral index (BIS) 60–80) with the unilateral spinal anesthesia (SA) on activity of daily living in elderly patients undergoing hip fracture surgery. Methods. A total of 124 elderly patients undergoing hip fracture surgery were randomly assigned to two groups. Patients in the SA group received light-specific gravity spinal anesthesia, and patients in the CLSB group received lumbar and sacral plexus block with general anesthesia (BIS 60–80). The primary outcomes were 30-day activity of daily living (ADL). The secondary outcomes were postoperative pain scores, postoperative delirium, in-hospital cost, and major complications. Results. The ADL scores of postoperative day 30 (POD30) in the CLSB group are higher than those in the SA group (27.34 ± 7.01 versus 24.70 ± 6.40, P = 0.045 ). Compared to preoperative ADL scores, there were higher increased scores in the CLSB group than in POD30 (CLSB group 8.09 ± 3.39 versus SA group 4.87 ± 3.90, P < 0.001 ). Mild-to-moderate pain did not have differences between the two groups (rest pain: 3 versus 2, P = 0.344 ; motion pain: 5 versus 4, P = 0.073 ). There were no significant differences in incidence of postoperative delirium, PONV, and other complications. Conclusion. The unilateral SA can reduce the deterioration of ADL after hip fracture surgery and provide a better postoperative recovery.

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