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

Anesthesia and Analgesia
Dong-Liang MuXue-Ying Li

Abstract

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. 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. 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 ...Continue Reading

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Citations

Jan 22, 2018·Aging Clinical and Experimental Research·Bruno NeunerGabriella Bettelli
Aug 8, 2018·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Chris FarlingerCamilla L Wong
Sep 1, 2018·Current Opinion in Anaesthesiology·Anastasia BorozdinaFederico Bilotta
Nov 10, 2017·Current Opinion in Anaesthesiology·Huiqun FuTianlong Wang
Jan 18, 2018·The Journal of Bone and Joint Surgery. American Volume·Gwo-Chin Lee
Feb 6, 2020·Anesthesia and Analgesia·Christopher G HughesUNKNOWN Perioperative Quality Initiative (POQI) 6 Workgroup
Mar 9, 2019·Journal of Pharmacy Practice·Chelsea R Wampole, Kathryn E Smith
Dec 6, 2019·Peptides·Richard J Bodnar
Aug 17, 2020·British Journal of Anaesthesia·Zhaosheng JinDaqing Ma
Nov 4, 2021·Anesthesiology·Brian P O'GaraBalachundhar Subramaniam
Jan 7, 2022·CNS Neuroscience & Therapeutics·Yang LiuTianlong Wang

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