Influence of Intraoperative Pain Management on Postoperative Delirium in Elderly Patients: A Prospective Single-Center Randomized Controlled Trial.

IF 4.1 2区医学 Q1 CLINICAL NEUROLOGY

Pain and Therapy Pub Date : 2025-02-01 Epub Date: 2025-01-05 DOI:10.1007/s40122-024-00702-6

Yuhao Du, Jiangbing Cao, Chen Gao, Keqiang He, Sheng Wang

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引用次数: 0

Abstract

Introduction: Intraoperative analgesia and sedation are closely related to postoperative delirium. Depth of sedation based on bispectral index (BIS) guidance has been shown to reduce the occurrence of postoperative delirium (POD). However, the correlation between intraoperative analgesia levels and POD is unclear. The aim of this study was to investigate the effect of intraoperative analgesic management guided by the nociceptive stimulus index (NOX) on postoperative delirium.

Methods: In this prospective single-center randomized controlled study, elderly patients aged 65 and above, who are scheduled to undergo unilateral total knee arthroplasty (TKA), were allocated into two groups: the routine monitoring group (group R), which solely monitored patient sedation levels using BIS; and the NOX monitoring group (group N), which monitored patient analgesic levels using NOX based on BIS-monitored sedation levels. The primary outcome was the incidence of postoperative delirium within 3 days after surgery, using the confusion assessment method (CAM).

Results: From May 2022 to December 2022, a total of 240 patients were randomized; 12 were excluded because of failure to meet experimental conditions or were lost to follow-up. Patients in group N had a lower incidence rate (%) of POD on the first day compared to those in group R (8 (7%) vs 18 (16%), P = 0.041). The dosage of remifentanil administered in group N was significantly higher than that in group R (927.07 ± 268.09 vs 882.32 ± 187.91 mg, P = 0.002).

Conclusions: Appropriate intraoperative analgesia guided by NOX is associated with POD. When sedation levels were consistent, the incidence of POD was significantly reduced in older patients with NOX-guided analgesic management during unilateral TKA surgery.

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术中疼痛处理对老年患者术后谵妄的影响：一项前瞻性单中心随机对照试验。

术中镇痛、镇静与术后谵妄密切相关。基于双谱指数（BIS）指导的镇静深度已被证明可以减少术后谵妄（POD）的发生。然而，术中镇痛水平与POD的相关性尚不清楚。本研究旨在探讨在伤害性刺激指数（NOX）指导下术中镇痛管理对术后谵妄的影响。方法：在这项前瞻性单中心随机对照研究中，将65岁及以上计划行单侧全膝关节置换术（TKA）的老年患者分为两组：常规监测组（R组），仅使用BIS监测患者镇静水平；氮氧化物监测组（N组），根据bis监测的镇静水平，使用氮氧化物监测患者的镇痛水平。主要观察指标为术后3天内谵妄的发生率，采用神志不清评估法（CAM）。结果：2022年5月至2022年12月，共纳入240例患者；12例因不符合实验条件或无法随访而被排除。N组患者第一天POD发生率（%）低于R组(8 （7%)vs 18 (16%), P = 0.041）。N组给予瑞芬太尼的剂量显著高于R组（927.07±268.09 vs 882.32±187.91 mg, P = 0.002）。结论：NOX引导下术中适当镇痛与POD相关。当镇静水平一致时，在单侧TKA手术中采用nox引导镇痛管理的老年患者，POD的发生率显著降低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pain and Therapy CLINICAL NEUROLOGY-

CiteScore

6.60

自引率

5.00%

发文量

110

审稿时长

6 weeks

期刊介绍： Pain and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of pain therapies and pain-related devices. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, acute pain, cancer pain, chronic pain, headache and migraine, neuropathic pain, opioids, palliative care and pain ethics, peri- and post-operative pain as well as rheumatic pain and fibromyalgia. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports, trial protocols, short communications such as commentaries and editorials, and letters. The journal is read by a global audience and receives submissions from around the world. Pain and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.