Intraoperative dexmedetomidine for prevention of postoperative delirium in pediatric patients after orthopedic surgery: a single-center retrospective study.

Abstract

Purpose: To evaluate the effectiveness of intraoperative dexmedetomidine in preventing postoperative delirium (POD) in pediatric patients undergoing lower extremity orthopedic surgery.

Methods: This retrospective study included pediatric patients aged 3-12 years who underwent lower extremity orthopedic surgery and received single-shot caudal block combined with intravenous patient-controlled analgesia (IV-PCA) from January 2021 to December 2023. Patients were divided into two groups according to intraoperative adjuvant medication: dexmedetomidine (1 µg/kg) or sufentanil (0.1 µg/kg). Propensity score matching (PSM) was used to balance baseline characteristics. The primary outcome was the incidence of POD, assessed by the Pediatric Anesthesia Emergence Delirium (PAED) scale. Secondary outcomes included postoperative pain scores (r-FLACC scale) and adverse events.

Results: After PSM, 128 patients (64 pairs) were analyzed. The incidence of POD was significantly lower in the dexmedetomidine group compared to the sufentanil group (14.1% vs. 34.4%, p = 0.01). Multivariate logistic regression revealed that intraoperative dexmedetomidine was independently associated with a reduced risk of POD (OR = 0.29, 95% CI: 0.12-0.74, p < 0.01). Dexmedetomidine also resulted in lower r-FLACC pain scores in the PACU and during the first 6 h postoperatively (all p < 0.01). No significant differences in hemodynamic changes or adverse events were observed between the groups.

Conclusion: Intraoperative dexmedetomidine significantly reduces the incidence of POD and improves early postoperative pain control in pediatric patients undergoing lower extremity orthopedic surgery, without increasing adverse events.