Prophylactic administration of parecoxib sodium for postoperative delirium in hip surgery of the elderly: a prospective, randomized, placebo-controlled trial.

Objective: The aim of this study was to evaluate the effect of prophylactic administration of parecoxib sodium on postoperative delirium in elderly orthopedic patients.

Methods: In this prospective, single-center, randomized, double-blind, placebo-controlled trial, a total of 166 elderly orthopedic patients were included. Patients were randomly divided into placebo group (Group A) and parecoxib sodium group (Group B) with normal saline and parecoxib sodium 40 mg given, respectively, before operation. Delirium was evaluated by the Confusion Assessment Method-Chinese Reversion. The main outcome was the incidence of delirium within 48 h after operation. The secondary outcomes were the average delirium and pain scores. The follow-up outcome was measured by the Activities of Daily Living scale after 2 months and 6 months.

Results: Finally, 53 of 166 patients developed postoperative delirium (31.9%), of which the incidence of Group B was significantly lower than that of Group A (42.2 vs. 21.7%, p=0.015). The average delirium scores of Group B were lower than those of Group A (p<0.05). However, the average pain scores only differed at 8 pm in the second day after surgery. There was no significant difference in Activities of Daily Living scale scores between the two groups at either 2 months (67.12±19.82 vs. 65.19±19.53, p=0.609) or 6 months (68.36±18.56 vs. 66.63±19.44, p=0.927).

Conclusion: Preoperative prophylactic administration of parecoxib sodium significantly reduced the incidence of postoperative delirium in elderly orthopedic patients but did not improve long-term functional recovery.