| Title | Parecoxib Supplementation to Morphine Analgesia Decreases Incidence of Delirium in Elderly Patients After Hip or Knee Replacement Surgery: A Randomized Controlled Trial |
| Authors | Mu, Dong-Liang Zhang, Da-Zhi Wang, Dong-Xin Wang, Geng Li, Chun-Jing Meng, Zhao-Ting Li, Ya-Wei Liu, Chao Li, Xue-Ying |
| Affiliation | Peking Univ, Hosp 1, Dept Anesthesiol, Beijing, Peoples R China. Peking Univ, Hosp 1, Dept Crit Care Med, Beijing, Peoples R China. Peking Univ, Hosp 1, Dept Biostat, Beijing, Peoples R China. Beijing Jishuitan Hosp, Dept Anesthesiol, Beijing, Peoples R China. Peking Univ, Hosp 1, Dept Anesthesiol & Crit Care Med, Beijing 100034, Peoples R China. |
| Keywords | CONFUSION ASSESSMENT METHOD POSTOPERATIVE DELIRIUM RISK-FACTORS PAIN MANAGEMENT COGNITIVE DYSFUNCTION JOINT ARTHROPLASTY CYCLOOXYGENASE-2 INHIBITORS NONCARDIAC SURGERY DOUBLE-BLIND FRACTURE |
| Issue Date | 2017 |
| Publisher | ANESTHESIA AND ANALGESIA |
| Citation | ANESTHESIA AND ANALGESIA.2017,124(6),1992-2000. |
| Abstract | BACKGROUND: Severe pain and high-dose opioids are both associated with increased risk of postoperative delirium. The authors investigated whether parecoxib-supplemented IV morphine analgesia could decrease the incidence of delirium in elderly patients after total hip or knee replacement surgery. METHODS: In a randomized, double-blind, 2-center trial, patients of 60 years or older who underwent elective total hip or knee replacement surgery were assigned in a 1: 1 ratio to receive either parecoxib (40 mg at the end of surgery and then every 12 hours for 3 days) or placebo (normal saline). All patients received combined spinal-epidural anesthesia during surgery and IV morphine for postoperative analgesia. The primary outcome was the incidence of delirium within 5 days after surgery. RESULTS: Between January 2011 and May 2013, 620 patients were enrolled and were included in the intention-to-treat and safety analyses. The incidence of delirium was significantly reduced from 11.0% (34/310) with placebo to 6.2% (19/310) with parecoxib (relative risk 0.56, 95% confidence interval 0.33-0.96, P =.031). The severity of pain and the cumulative consumptions of morphine at 24, 48, and 72 hours after surgery were significantly lower with parecoxib than with placebo (all P <.001), although the differences were small. There was no difference in the incidence of postoperative complications between the 2 groups (12.3% [38/310] with placebo versus 11.6% [36/310] with parecoxib; P =.80). CONCLUSIONS: For low-risk elderly patients undergoing elective total hip or knee replacement surgery, multidose parecoxib supplemented to IV morphine decreased the incidence of postoperative delirium without increasing adverse events. |
| URI | http://hdl.handle.net/20.500.11897/469168 |
| ISSN | 0003-2999 |
| DOI | 10.1213/ANE.0000000000002095 |
| Indexed | SCI(E) SSCI |
| Appears in Collections: | 第一医院 |
