Regional anesthesia effectively reduces likelihood of postoperative delirium

China: In a new study conducted by Tao Li and colleagues, it was found that regional anesthesia significantly correlated with a reduction in postoperative delirium (POD) occurrence, POD score, and pain score. The findings of this study were published in Frontiers in Surgery.

Up to 5 days following surgery, postoperative delirium might arise in the recovery area. Regional anesthesia's impact on POD, according to the POD recommendations published by the European Society of Anesthesiology (ESA), is debatable. In order to determine if perioperative regional anesthesia decreased the incidence of POD, this meta-analysis was carried out.

To find any evidence that documented regional anesthesia measuring incident delirium following various procedures, standard published randomized controlled trials (RCTs) were searched from bibliographic sources. The occurrence of POD was the main outcome, whereas POD scores, pain scores, and emergence time were the secondary outcomes. 

The key highlights of this study:

1. Twenty RCTs were included, with 2110 randomly assigned patients getting various operations.

2. A meta-analysis revealed that as compared to total intravenous anesthesia (TIVA) or inhalation anesthesia, regional anesthesia was linked with a lower incidence of POD.

3. The reduction in POD incidence was linked to a nerve block and regional-combined-general anesthesia, according to subgroup analysis.

4. Following pediatric procedures, regional anesthesia greatly decreased the occurrence of POD in the recovery area.

5. The POD and pain scores were both decreased with regional anesthesia.

6. In terms of emergence time, there was no discernible difference between regional and general anesthesia.

In conclusion, the authors found this study demonstrated a decrease in both the POD incidence and POD score by regional anesthetics. Children in the PACU show this impact of regional anesthesia more so than senior patients do over the first 1 to 5 days after surgery.

"Our results are somewhat complementary to the guidelines as there isn't a lot of solid evidence for regional anesthesia on POD in the guidelines. To validate the current findings, further investigations with sizable sample sizes are still required," they wrote. 

Reference:

Li, T., Dong, T., Cui, Y., Meng, X., & Dai, Z. (2022). Effect of regional anesthesia on the postoperative delirium: A systematic review and meta-analysis of randomized controlled trials. In Frontiers in Surgery (Vol. 9). Frontiers Media SA. https://doi.org/10.3389/fsurg.2022.937293