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Spinal Dexamethasone Effect on Cognitive Disorders After Hip Surgery.

Livija Sakic1,2,3, Dinko Tonkovicc3,4, Zlatko Hrgovic5

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Intrathecal dexamethasone with levobupivacaine for proximal femoral fractures reduced postoperative pain and cognitive issues. This anesthesia approach improved patient recovery and shortened hospital stays.

Keywords:
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Area of Science:

  • Anesthesiology
  • Trauma Surgery
  • Geriatric Medicine

Background:

  • Proximal femoral fractures (PrFF) are a common cause of emergency admission in the elderly.
  • Elderly patients often have comorbidities that are exacerbated by emergency surgery.

Purpose of the Study:

  • To evaluate the efficacy of a single intrathecal injection of dexamethasone with levobupivacaine.
  • To determine if this combination reduces postoperative pain and cognitive complications in patients with PrFF.

Main Methods:

  • A randomized study involving 60 patients with PrFF (ASA status 2 or 3).
  • Patients received either spinal anesthesia with dexamethasone and levobupivacaine (DLSA group) or levobupivacaine alone (LSA group).
  • Outcomes assessed included pain (VAS), cognitive function (CAM scale), and plasma cortisol levels.

Main Results:

  • The DLSA group showed a reduced incidence of postoperative cognitive dysfunction (POCD) (p=0.043).
  • Longer duration of analgesia (p<0.001), decreased cortisol levels, and shorter hospitalization (p=0.045) were observed in the DLSA group.
  • Intrathecal dexamethasone was a significant predictor of reduced postoperative delirium (OR 7.76, p=0.019).

Conclusions:

  • Single-shot intrathecal dexamethasone with levobupivacaine effectively reduces the stress response in PrFF anesthesia.
  • This method prolongs analgesia, decreases cortisol levels, and lowers the frequency of delirium and POCD.
  • Improved postoperative rehabilitation and shorter hospital stays are key benefits, leading to better patient outcomes.