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Effect of intraoperative methylene blue on postoperative delirium in elderly patients undergoing joint replacement: a
Wen Zhang1,2,3, Fei Ling1,2, Junwei Qi1,2
1Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University,Xuzhou,Jiangsu Province,China.
Background:
Postoperative delirium (POD) is one of the most prevalent postoperative complications after joint replacement surgery that has great impact on patients' outcomes. Methylene blue (MB) is reported to decrease the incidence of POD. In the current study, the authors investigated whether MB would reduce the incidence of POD in elderly patients undergoing joint replacement surgery.
Material And Methods:
In total, 217 elderly patients undergoing joint replacement surgery were randomly assigned to the MB group ( n = 109) or the control group ( n = 108). The MB group received a continuous intravenous infusion of 50 mL of a mixture of 2 mg/kg MB and 5% glucose solution within 60 minutes of anesthesia induction, and the control group received a continuous infusion of an equivalent volume of 5% glucose solution. The rate of POD in both groups, 5 days following surgery, was the primary endpoint. The secondary outcomes were delirium characteristics, postoperative pain score, telephone interview for cognitive status-modified score 1 month after surgery, and the type and incidence of adverse events (AEs).
Results:
A total of 31 patients (14.3%) experienced POD. The incidence of POD in the MB group was significantly lower than that in the control group (8.3% vs. 20.4%, hazard ratio = 0.39; 95% confidence interval: 0.173-0.858; P = 0.024). Postoperative fever was substantially more common in the MB group (16.5%) than in the control group (7.4%, P = 0.039). Nevertheless, the proportions of patients with other AEs were similar between the two groups.
Conclusions:
In older patients undergoing joint replacement surgery, intraoperative intravenous infusion of 2 mg/kg MB can lower the incidence of POD during hospitalization, but it does not significantly increase the incidence or severity of AEs.
Insights
Methylene blue (MB) infusion significantly reduced postoperative delirium (POD) in elderly joint replacement patients. While fever was more common, overall adverse events were similar, indicating MB
Area of Science:
- Anesthesiology
- Geriatric Medicine
- Surgical Complications
Background:
- Postoperative delirium (POD) is a frequent complication after joint replacement surgery, significantly impacting patient outcomes.
- Methylene blue (MB) has shown potential in reducing POD incidence.
Purpose of the Study:
- To investigate the efficacy of intraoperative Methylene blue (MB) in reducing the incidence of postoperative delirium (POD) in elderly patients undergoing joint replacement surgery.
Main Methods:
- A randomized controlled trial involving 217 elderly patients undergoing joint replacement surgery.
- Patients were assigned to receive either Methylene blue (MB) (2 mg/kg IV) or a placebo (5% glucose solution) during anesthesia induction.
- Primary endpoint was the rate of POD within five days post-surgery; secondary outcomes included delirium characteristics, pain scores, cognitive function, and adverse events.
Main Results:
- The incidence of POD was significantly lower in the MB group (8.3%) compared to the control group (20.4%) (P=0.024).
- Postoperative fever occurred more frequently in the MB group (16.5%) than the control group (7.4%) (P=0.039).
- No significant differences were observed in other adverse events between the groups.
Conclusions:
- Intraoperative intravenous Methylene blue (MB) administration effectively reduces the incidence of postoperative delirium (POD) in elderly patients undergoing joint replacement surgery.
- MB infusion did not significantly increase the overall incidence or severity of adverse events, despite a higher rate of postoperative fever.
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