Postoperative Delirium After Dexmedetomidine versus Propofol Sedation in Older Adults Undergoing Hip Fracture Surgery with Spinal Anesthesia: A Randomized Controlled Trial

Abstract

Purpose Postoperative delirium is a prevalent complication in elderly surgical patients and is associated with adverse outcomes, including prolonged hospitalization and long-term cognitive impairment. Dexmedetomidine, a highly selective α2-adrenergic receptor agonist, has pharmacological properties that suggest it may reduce the incidence of postoperative delirium. This randomized controlled trial aimed to compare the incidence of postoperative delirium in elderly patients undergoing hip fracture repair under spinal anesthesia with propofol versus dexmedetomidine sedation. Patients and Methods This multicenter, randomized, double-blind, parallel-group trial enrolled patients from 12 centers between September 2017 and July 2020. A total of 834 patients scheduled for hip fracture surgery were randomly assigned to receive either dexmedetomidine or propofol for intraoperative sedation. The primary outcome was the incidence of postoperative delirium within 72 hours postoperatively. Secondary outcomes included postoperative pain scores and other complications. Results The incidence of postoperative delirium was significantly lower in the dexmedetomidine group compared to the propofol group (4.0% vs 7.8%; P = 0.021). Additionally, the dexmedetomidine group exhibited a lower incidence of postoperative headache than the propofol group (3.4% vs 1.7%; P = 0.04). Conclusion Dexmedetomidine sedation reduces the incidence of postoperative delirium in elderly patients undergoing hip fracture surgery under spinal anesthesia combined with iliac fascia block, compared to propofol sedation. Trial Registration ClinicalTrials.gov, NCT03346226. Principal investigator: Zhanggang Xue. Registered on 14 September 2017.