Related Experiment Video
Updated: Dec 2, 2025
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
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.
Background:
Delirium is a common complication after proximal femoral fracture surgery, with pain and opioid consumption as the contributing factors. The administration of intrathecal morphine may decrease these factors postoperatively and potentially reduce delirium.
Objectives:
This research aimed to study the association between the use of intrathecal morphine and the occurrence of delirium.
Methods:
A retrospective analysis of a prospective register kept in a non-academic hospital in the Netherlands was performed. The register contained data of all patients with proximal femur fractures that were surgically treated with osteosynthesis or prosthesis. Patients receiving spinal anesthesia (SA group) were compared with patients receiving spinal anesthesia with the addition of intrathecal morphine (SIM group). The administration of either SA or SIM was based on the preference of the anesthesiologist. The primary outcome was the incidence of delirium, as defined by the DSM-V classification. The follow-up lasted until hospital discharge. Both univariate and multivariate analyses were performed.
Results:
The SA group consisted of 451 patients, and the SIM group included 34 patients. Delirium occurred in 19.7% in the SA group versus 5.9% in the SIM group (P = 0.046). This association remained significant after correction in multivariate analysis (OR of delirium in the SA group, 95% CI: 1.062 - 21.006, P = 0.041). Additionally, multivariate analysis revealed that age, gender, preoperative cognitive impairment, and fracture treatment (osteosynthesis or prosthesis) were independently associated with delirium.
Conclusions:
This retrospective study found an independent association between the use of intrathecal morphine and a lower incidence of delirium. This clinically relevant decrease in delirium should be studied in a prospective randomized study.
Insights
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.
