Impact of Dexamethasone on the stress response during perioperative management of elderly patients with hip fracture

Abstract

Introduction: Hip fracture is the most common cause of emergency hospital admissions among the elderly population and is associated with high postoperative morbidity. The hypothesis is that a single intrathecal dose of Dexamethasone with Levobupivacaine for surgical correction of hip fracture reduces surgical stress and contributes to better treatment outcomes. Method: Elderly patients with hip fracture who underwent surgery under spinal anesthesia with Levobupivacaine were analyzed, with one group receiving a single intrathecal dose of Dexamethasone and the other group serving as a control (group DLSA/control group LSA). The following variables were monitored: gender, type of injury, cortisol levels, time elapsed from injury to surgical intervention, pain intensity, occurrence of delirium, postoperative cognitive deficits and other complications, length of hospital stay, and mortality. Results: Reduced cortisol concentrations, prolonged analgesia duration, and shorter hospitalization duration were observed in DLSA group, compared to the LSA group. Conclusion: A single intrathecal injection of Dexamethasone in spinal anesthesia for surgical correction of hip fracture reduces perioperative stress response by lowering plasma cortisol concentration, providing a longer analgesic effect, reducing the incidence of delirium and POCD (Postoperative Cognitive Dysfunction), and improving rehabilitation prospects. This leads to a shorter hospitalization duration, justifying this anesthetic approach as a recommended method of choice.