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Minerva Anestesiologica 2022 June;88(6):499-507

DOI: 10.23736/S0375-9393.22.16076-1


lingua: Inglese

Regional anesthesia techniques and postoperative delirium: systematic review and meta-analysis

Andrea FANELLI 1 , Eleonora BALZANI 2, Stavros MEMTSOUDIS 3, 4, Faraj W. ABDALLAH 5, 6, Edward R. MARIANO 7, 8

1 Anesthesia, Intensive Care and Pain Therapy Unit, Department of Emergency and Urgency, Istituto ad Alta Specializzazione Policlinico di Monza, Monza, Monza-Brianza, Italy; 2 Department of Surgical Sciences, University of Turin, Turin, Italy; 3 Weill Cornell Medicine, New York, NY, USA; 4 Hospital for Special Surgery, New York, NY, USA; 5 Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; 6 Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; 7 Stanford University School of Medicine, Stanford, CA, USA; 8 Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA

INTRODUCTION: Postoperative delirium is a frequent occurrence in the elderly surgical population. As a comprehensive list of predictive factors remains unknown, an opioid-sparing approach incorporating regional anesthesia techniques has been suggested to decrease its incidence. Due to the lack of conclusive evidence on the topic, we conducted a systematic review and meta-analysis to investigate the potential impact of regional anesthesia and analgesia on postoperative delirium.
EVIDENCE ACQUISITION: PubMed, Embase, and the Cochrane central register of Controlled trials (CENTRAL) databases were searched for randomized trials comparing regional anesthesia or analgesia to systemic treatments in patients having any type of surgery. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We pooled the results separately for each of these two applications by random effects modelling. Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the certainty of evidence and strength of conclusions.
EVIDENCE SYNTHESIS: Eighteen trials (3361 subjects) were included. Using regional techniques for surgical anesthesia failed to reduce the risk of postoperative delirium, with a relative risk (RR) of 1.21 (95% CI: 0.79 to 1.85); P=0.3800. In contrast, regional analgesia reduced the relative risk of perioperative delirium by a RR of 0.53 (95% CI: 0.42 to 0.68; P<0.0001), when compared to systemic analgesia. Post-hoc subgroup analysis for hip fracture surgery yielded similar findings.
CONCLUSIONS: These results show that postoperative delirium may be decreased when regional techniques are used in the postoperative period as an analgesic strategy. Intraoperative regional anesthesia alone may not decrease postoperative delirium since there are other factors that may influence this outcome.

KEY WORDS: Conduction anesthesia; Postoperative complications; Delirium; Perioperative care

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