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Intrathecal Morphine Is Associated with Less Delirium Following Hip Fracture Surgery: A Register Study
Mark Vincent Koning1,2, Max van der Sijp3,4, Robert Jan Stolker2
1Department of Anesthesiology and Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands.
Anesthesiology and Pain Medicine
|November 2, 2020
Summary
Intrathecal morphine may reduce delirium after proximal femoral fracture surgery. This study found a lower delirium incidence in patients receiving intrathecal morphine compared to standard spinal anesthesia.
Area of Science:
- Anesthesiology
- Geriatric Surgery
- Postoperative Care
Background:
- Delirium is a frequent complication following proximal femoral fracture surgery.
- Pain and opioid use are key contributors to postoperative delirium.
- Intrathecal morphine could mitigate these factors and reduce delirium incidence.
Purpose of the Study:
- To investigate the association between intrathecal morphine administration and the occurrence of delirium.
- To determine if intrathecal morphine impacts delirium rates in patients undergoing proximal femur fracture surgery.
Main Methods:
- Retrospective analysis of a prospective register from a Dutch hospital.
- Comparison of patients receiving spinal anesthesia (SA) versus spinal anesthesia with intrathecal morphine (SIM).
- Delirium incidence assessed using DSM-V criteria, with univariate and multivariate analyses performed.
Main Results:
- Lower delirium incidence in the SIM group (5.9%) compared to the SA group (19.7%) (P=0.046).
- This association remained significant in multivariate analysis (OR 1.062-21.006, P=0.041).
- Age, gender, preoperative cognitive status, and fracture treatment were independent predictors of delirium.
Conclusions:
- Intrathecal morphine is independently associated with a reduced incidence of delirium post-proximal femoral fracture surgery.
- The observed decrease in delirium is clinically significant.
- Further investigation via a prospective randomized study is warranted.
