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Regional anesthesia techniques and postoperative delirium: systematic review and meta-analysis
Andrea Fanelli1, Eleonora Balzani2, Stavros Memtsoudis3,4
1Anesthesia, Intensive Care and Pain Therapy Unit, Department of Emergency and Urgency, Istituto ad Alta Specializzazione Policlinico di Monza, Monza, Monza-Brianza, Italy - andre.fanelli@gmail.com.
Minerva Anestesiologica
|February 15, 2022
Summary
Regional analgesia, not anesthesia, significantly reduces postoperative delirium risk in elderly patients. This systematic review highlights the benefits of regional techniques for pain management in preventing delirium after surgery.
Area of Science:
- Anesthesiology
- Geriatric Medicine
- Critical Care Medicine
Background:
- Postoperative delirium (POD) is common in elderly surgical patients.
- Opioid-sparing strategies, including regional anesthesia, are proposed to mitigate POD.
- Conclusive evidence on regional anesthesia's impact on POD is lacking.
Purpose of the Study:
- To systematically review and meta-analyze the impact of regional anesthesia and analgesia on postoperative delirium.
- To investigate the potential of regional techniques in reducing POD incidence.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched PubMed, Embase, and CENTRAL databases.
- Followed PRISMA guidelines; used random effects modeling and GRADE for evidence assessment.
Main Results:
- Eighteen trials with 3361 subjects were included.
- Regional anesthesia for surgical anesthesia did not reduce POD risk (RR 1.21, P=0.3800).
- Regional analgesia significantly reduced POD risk (RR 0.53, P<0.0001) compared to systemic analgesia.
Conclusions:
- Regional techniques used for postoperative analgesia can decrease delirium.
- Intraoperative regional anesthesia alone may not be sufficient to reduce POD.
- Further research into multifactorial influences on POD is warranted.
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