Use of Local anesthesia in postoperative phase reduces chance of delirium

Results of a new study conducted by Andrea Fanelli and peers show that usage of regional analgesic strategies in the postoperative phase might reduce postoperative delirium. The findings of this study were published in Minerva Anestesiologica.

Postoperative delirium is common in the senior surgical population. Although a thorough list of predicting indicators is unclear, an opioid-sparing strategy using regional anesthetic methods has been proposed to reduce its occurrence. Researchers did a systematic review and meta-analysis to explore the possible influence of regional anesthesia and analgesia on postoperative delirium due to a lack of clear information on the issue.

For randomized studies comparing localized anesthetic or analgesia to systemic therapies in patients undergoing any form of surgery, databases were searched. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed in this systematic review and meta-analysis. Random effects modeling was used to pool the findings for each of these two applications independently. To assess the certainty of evidence and the strength of findings, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was utilized.

The key findings of this study were:

1. There were eighteen trials (3361 individuals) involved.

2. With a relative risk (RR) of 1.21 (95% CI: 0.79 to 1.85; P=0.3800), using localized methods for surgical anesthetic failed to minimize the incidence of postoperative delirium.

3. When compared to systemic analgesia, localized analgesia reduced the relative risk of perioperative delirium by 0.53 (95% CI: 0.42 to 0.68; P0.0001).

4. A post-hoc subgroup study of hip fracture surgery revealed comparable results.

In conclusion, from the findings of this study, it is evident that numerous variables may impact surgical delirium, intraoperative regional anesthesia alone may not reduce it.

Reference: 

FANELLI, A., BALZANI, E., MEMTSOUDIS, S., ABDALLAH, F. W., & MARIANO, E. R. (2022). Regional anesthesia techniques and postoperative delirium: systematic review and meta-analysis. In Minerva Anestesiologica (Vol. 88, Issue 6). Edizioni Minerva Medica. https://doi.org/10.23736/s0375-9393.22.16076-1