Parecoxib Supplementation to Morphine Analgesia Decreases Incidence of Delirium in Elderly Patients After Hip or Knee Replacement Surgery: A Randomized Controlled Trial

Mu, Dong-Liang; Zhang, Dazhi; Wang, Dong‐Xin; Wang, Geng; Li, Chunjing; Meng, Zhaojun; Li, Yawei; Liu, Chao; Li, Xueying

doi:10.1213/ane.0000000000002095

Cited by 57 publications

(68 citation statements)

References 35 publications

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“…Prolonged hospital stay, sleep deprivation and postoperative pain may all contribute to postoperative cognitive dysfunction. Minimising length of hospital stay by implementing fast‐track surgery, optimising postoperative pain control (in particular avoiding opioids ), and improving sleep hygiene might decrease early postoperative cognitive dysfunction. All relevant staff should receive training in the evaluation and management of pain in patients with cognitive impairment .…”

Section: Postoperative Cognitive Disordersmentioning

confidence: 99%

Peri‐operative optimisation of elderly and frail patients: a narrative review

Chan

Irwin

2019

Anaesthesia

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With increasing life expectancy and technological advancement, provision of anaesthesia for elderly patients has become a significant part of the overall case-load. These patients are unique, not only because they are older with more propensity for comorbidity but a decline in physiological reserve and cognitive function invariably accompanies ageing; this can substantially impact peri-operative outcome and quality of recovery. Furthermore, it is not only morbidity and mortality that matters; quality of life is also especially relevant in this vulnerable population. Comprehensive geriatric assessment is a patient-centred and multidisciplinary approach to peri-operative care. The assessment of frailty has a central role in the pre-operative evaluation of the elderly. Other essential domains include optimisation of nutritional status, assessment of baseline cognitive function and proper approach to patient counselling and the decision-making process. Anaesthetists should be proactive in multidisciplinary care to achieve better outcomes; they are integral to the process. Twitter: @mgirwin advanced age [2]. Although chronological age itself predicts surgical outcome poorly, age-related decline in physiological reserve and functional capacity are inevitable, and affect all organ systems. When people live longer, more comorbidities appear; this will result in higher rates of peri-operative morbidity and mortality. This is already imposing a significant burden on healthcare systems, by increasing both the utilisation of intensive care facilities and length of hospital stay [3,4]. Therefore, it is imperative to deliver both high-quality and efficient peri-operative care for elderly patients.The 'elderly' represent a unique group of patients, with many challenges for the peri-operative care team. In this article, we review the following aspects of anaesthesia in the elderly: (1) the role of comprehensive geriatric assessment and innovative models of care; (2) the implications of frailty and its assessment; (3) the assessment and optimisation of nutritional status; (4) the assessment of neurocognitive dysfunction; and (5) patient counselling and approach to decision-making. 80

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Section: Postoperative Cognitive Disordersmentioning

confidence: 99%

Peri‐operative optimisation of elderly and frail patients: a narrative review

Chan

Irwin

2019

Anaesthesia

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“…All included studies were randomized controlled trials. In summary, 17 studies [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] described random sequence generation and allocation concealment. Nine studies [12-14, 20, 22, 24, 25, 27, 28] described the blinding of participants and personnel.…”

Section: Evaluating Literature Qualitymentioning

confidence: 99%

The efficacy and safety of selective COX-2 inhibitors for postoperative pain management in patients after total knee/hip arthroplasty: a meta-analysis

et al. 2020

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Background: Many selective cyclooxygenase (COX-2) inhibitors are currently used in clinical practice. COX-2 inhibitors have good anti-inflammatory, analgesic, antipyretic effects, and gastrointestinal safety. However, the analgesic effects and adverse reactions of COX-2 after total knee/hip arthroplasty (TKA/THA) are not fully known. Objective: To evaluate the efficacy and safety of selective COX-2 inhibitors in postoperative pain management in patients receiving TKA/THA. Methods: Randomized controlled trials (RCTs) were retrieved from medical literature databases. Risk ratios (RR) Std mean difference (SMD) and 95% confidence intervals (CI) were calculated to analyze the primary and safety endpoints. Results: In total, 18 articles (23 trial comparisons) were retrieved comprising 3104 patients. Among them, 1910 patients (61.5%) were randomized to the experimental group whereas 1194 patients (38.5%) were randomized to the control group. The primary endpoints were the patients' VAS score at rest or on ambulation (within 3 days). We found that VAS score in patients that received selective COX-2 inhibitor was significantly lower compared to those of the control group. Conclusion: This meta-analysis shows that selective COX-2 inhibitor therapy is effective, safe, and reliable in relieving postoperative pain of THA/TKA.

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“…1 Increased postoperative pain has been associated with the occurrence of delirium and a previous randomizedcontrolled trial (RCT) investigating parecoxib, a selective cyclooxygenase-2 inhibitor, reduced the consumption of opioids and decreased delirium following total hip or knee replacement surgery. 2 Pregabalin is a structural analogue of c-aminobutyric acid. A meta-analysis of pregabalin for postoperative pain management found it may have a small opioid-sparing effect with a higher risk of serious adverse effects, but it is unclear if its opioid-sparing properties could also decrease postoperative delirium.…”

Section: To the Editormentioning

confidence: 99%

“…Despite the decreases in adjunct opioid utilization and better postoperative analgesia with pregabalin that we reported previously, our study found no effect of pregabalin on postoperative delirium following elective total hip arthroplasty. All patients received a selective cyclooxygenase-2 inhibitor perioperatively, which reduces postoperative delirium, 2 and thus may have nullified any effect of pregabalin. Other limitations of this analysis include a sample size powered for the original study's primary outcome; so we were likely underpowered to examine delirium in light of its unexpectedly lower incidence.…”

Section: To the Editormentioning

confidence: 99%

Perioperative pregabalin and delirium following total hip arthroplasty: a post hoc analysis of a double-blind randomized placebo-controlled trial

Clarke

Wong

2018

Can J Anesth/J Can Anesth

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Parecoxib Supplementation to Morphine Analgesia Decreases Incidence of Delirium in Elderly Patients After Hip or Knee Replacement Surgery: A Randomized Controlled Trial

Abstract: 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.

Cited by 57 publications

References 35 publications

Peri‐operative optimisation of elderly and frail patients: a narrative review

Peri‐operative optimisation of elderly and frail patients: a narrative review

The efficacy and safety of selective COX-2 inhibitors for postoperative pain management in patients after total knee/hip arthroplasty: a meta-analysis

Perioperative pregabalin and delirium following total hip arthroplasty: a post hoc analysis of a double-blind randomized placebo-controlled trial

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