PREVENTION OF POSTOPERATIVE DELIRIUM IN PATIENTS OF ELDERLY AND SENILE AGE IN ORTHOPEDIC PRACTICE

Abstract

The aim of the study was to reduce the frequency of postoperative delirium development in elderly and elderly patients who underwent operative intervention on the hip and knee joints, acetabulum, tubular bones of the lower limb by epidural morphine administration. Materials and methods: a retrospective analysis of the medical records of 113 patients of the Department of Traumatology and Orthopedics was performed, during which two groups of patients were compared, in one of which epidural analgesia was supplemented with the administration of 3 mg of morphine epidurally, in the second, regional anesthesia combined with a systemic introduction of analgesics; the obtained data were processed using statistical analysis methods. Conclusion: the study found that in patients who underwent analgesia by epidural administration of 3mg of 1% morphine solution, the frequency of postoperative delirium development was significantly lower than in the group with systemic analgesia.

Keywords

epidural anesthesia / morphine / postoperative delirium

References

[1] Корячкин В.А., Заболотский Д.В., Кузьмин В.В., Анисимов О.Г., Ежевская А.А., Загреков В.И. Анестезиологическое обеспечение переломов проксимального отдела бедренной кости у пожилых и престарелых пациентов (клинические рекомендации. Регионарная анестезия и лечение острой боли. 2017; 11 (2): 133-42.

[2] Kanis J.A., Odén A., McCloskey E.V., Johansson H., Wahl D.A., Cooper C. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. 2012; 23 (9): 2239-56.

[3] Страшнов В.И., Забродин О.Н., Мамедов А.Д., Страшнов А.В., Корячкин В.А. Предупреждение интраоперационного стресса и его последствий. СПб.: ЭЛБИ-СПб. 2015: 176.

[4] Rodgers A., Walker N., Schug S., McKee A., Kehlet H., van Zundert A. Reduction in postoperative mortality and morbidity with epidural or spinal anesthesia: Results from overview of randomized trials. BMJ. 2000; 321: 1-12.

[5] Ибрагимов Н.Ю. Послеоперационный делирий: критерии и факторы риска. В кн.: Ибрагимов Н.Ю., Лебединский К.М., Микиртумов Б.Е. Вестник хирургии имени Грекова И.И. 2008; 4: 124-7.

[6] Овечкин А. М. Послеоперационная боль: состояние проблемы и современные тенденции послеоперационного обезболивания. Регионарная анестезия и лечение острой боли. 2015; 9 (2): 29-39.

[7] Fong H.K., Sands L.P., Leung J.M. The role of postoperative analgesia in delirium and cognitive decline in elderly patients: a systematic review. Anesth. Analg. 2006; 102 (4): 1255-66.

[8] Neto A.S., Nassar A.P., Cardoso S.O. Manetta J.A., Pereira V.G., Espósito D.C. Delirium screening in critically ill patients: A systematic review and meta-analysis. Critical Care Medicine. 2012; 40 (6): 1946-51.

[9] Contín A.M., Perez-Jara J., Alonso-Contín A., Enguix A., Ramos F. Postoperative delirium after elective orthopedic surgery. Int. J. Geriatr. Psychiatry. 2005; 20 (6): 507-607.

[10] Корячкин В.А. Послеоперационный делирий: факторы риска и профилактика в ортопедо-травматологической практике Травматология и ортопедия России. 2013; 68 (2): 128-35.

[11] Заболотский Д.В., Корячкин В.А., Ульрих Г.Э. Послеоперационная анальгезия у детей. Есть ли доступные методы сегодня? (современное состояние проблемы). Регионарная анестезия и лечение острой боли. 2017; 11 (2): 64-73.

[12] Zaslansky R., Rothaug J., Chapman R.C., Backström R., Brill S., Engel C. et al. Pain out: an in- ternational acute pain registry supporting clinicians in decision making and in quality improvement activities. J. of Evaluation in Clinical Practice. 2014; 20 (6): 1090-8.

[13] Youssef N., Orlov D., Alie T., Chong M., Cheng J., Thabane L. et al. What epidural opioid results in the best analgesia outcomes and fewest side effects after surgery? A meta-analysis of randomized controlled trials. Anesth. Analg. 2014; 119 (4): 965-77.

[14] Lang M.R., Michelle B., Richard B.D., Frank A.F. Recommendations for chamber quantification. Eur. J. Echocardiography. 2006; 7 (2): 79-108.

[15] Рудомёткин С.Г., Трембач Н.В., Заболотских И.Б. Прогнозирование послеоперационного делирия у пожилых пациентов, подвергающихся обширным оперативным вмешательствам на органах брюшной полости. Кубанский научный медицинский вестник. 2012; 4: 91-5.

[16] Sessler C.N., Gosnell M.S., Grap M.J., Brophy G.M., O’Neal P.V., Keane K.A. et al. “The Richmond Agitation-Sedation Scale”. American Journal of Respiratory and Critical Care Medicine. 2002; 166 (10): 1338-44.

[17] Behar M., Olshwang D., Magora F., Davidson J.T. Epidural morphine in treatment of pain. The Lancet. 1979; 313 (8115): 527-9.

[18] Takenaka-Hamaya C., Hamaya Y., Dohi S. Epidural morphine injection after combined spinal and epidural anaesthesia. Eur J Anaesthesiol. 2002; 19 (9): 672-676.

[19] Shah O.M., Bhat K.M. Comparison of the Efficacy and Safety of Morphine and Fentanyl as Adjuvants to Bupivacaine in Providing Operative Anesthesia and Postoperative Analgesia in Subumblical Surgeries Using Combined Spinal Epidural Technique. Anesth. Essays Res. 2017; 11(4): 913-20.

[20] Кобеляцкий Ю.Ю. Расширение возможностей периоперационной анальгезии. Медицина неотложных состояний. 2012; 2: 57-62.

[21] Chaput A.J., Bryson G.L. Postoperative delirium: risk factors and management: continuing professional development. Can. J. Anaesth. 2012; 59 (3): 304-20.

[22] Nie H., Zhao B., Zhang Y.Q., Jiang Y.H., Yang Y.X. Pain and cognitive dysfunction are the risk factors of delirium in elderly hip fracture Chinese patients. Arch. Gerontol. Geriatr. 2012; 54 (2): 172-4.

RIGHTS & PERMISSIONS

Eco-Vector