The Comparison of Incidence and Risk Factors of Postoperative Delirium in Elderly Patients After Lower Extremity Surgery

Çukurova University

Status: Completed

Conditions: Postoperative Delirium

Treatments: Behavioral: propofol and esmeron(rokuronyum); Behavioral: marcaine and fentanyl

Study type: Observational

Funder types: Other

Identifiers

NCT02360982

cukurova university

Details and patient eligibility

About

The aim of this study is to compare the risk factors and the incidence of delirium following orthopedic surgery under the general or regional anesthesia in elderly patients.

Full description

One hundred twenty elderly patients aged ≥65 years scheduled for total hip or knee arthroplasty and femur fracture surgery were enrolled into the study. Patients were allocated into two groups to receive regional anesthesia (group R, n=50) or general anesthesia (group G, n=70). Hemodynamic and blood parameters, potential risk factors of delirium including age, sex, duration of surgery, the type of anesthesia, coexisting disease, smoking and amount of drug used delirium tests (CAM and DRS-R-98), hospital stay and costs were recorded for all patients.

Enrollment: 120 patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• American Society of Anesthesiologists physical status I-III,
• 120 patients aged ≥65 years scheduled for total hip or knee arthroplasty and femur fracture surgery

Exclusion criteria

• Exclusion criteria were patient refusal, abuse of alcohol and/or drugs
• Hypersensitivity to local anesthetics
• Vertebral abnormality
• Previous lumbar vertebra surgery
• Coagulation disorder
• Infection (systemic or local)
• Cerebrovascular disease
• Neurosurgery
• Vascular surgery
• Frequent use of analgesic drug
• ≥5 drugs per day and psychiatric medication

Trial design

120 participants in 2 patient groups

propofol and esmeron(rokuronyum)

Description:

In group G, anesthesia was induced with iv propofol (2 mg.kg-1) and maintained with 2% sevoflurane in a mixture of 65 % nitrous oxide and 35 % oxygen with a total gas flow rate of 6 L min-1. Neuromuscular relaxation was induced with iv rocuronium (esmeron) (0.5 mg.kg-1). Intravenous infusion of 0.9% saline was administered at a volume of 5 mL/kg/h. Patients received morphine (0.1mg/kg) for postoperative analgesia 30 minutes before the end of the operation. Anesthesia was terminated and neuromuscular blockade was antagonized with neostigmine (0.05 mg.kg-1)and atropine sulphate (0.01 mg.kg-1).

Treatment:

Behavioral: marcaine and fentanyl

Behavioral: propofol and esmeron(rokuronyum)

marcaine and fentanyl

Description:

We inserted a 18-G Tuohy needle at the L3/L4 or L2/L3 intervertebral epidural space using an epidural loss of resistance technique and thus performed needle-through-needle technique for subarachnoid injection of 2 mL bupivacaine (marcaine)(0.5%) and fentanyl (25 mcg) by 27-G spinal needle. After subarachnoid injection, epidural catheter was advanced and fixed. At the end of the surgery 5 mL of bupivacaine 0.5% plus morphine (1 mg), adding to 4 mL saline was injected via epidural catheter for postoperative analgesia.Epidural catheter was removed at 24th hours

Treatment:

Behavioral: marcaine and fentanyl

Behavioral: propofol and esmeron(rokuronyum)