Effect of Intranasal Dexmedetomidine on the Night Before Surgery for Postoperative Delirium in Older Patients Undergoing Total Hip or Knee Arthroplasty: A Randomized Clinical Trial.

Study Summary

232 patients aged 60 years or older undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) under general anaesthesia were randomized to receive 100 μg of intranasal dexmedetomidine or saline placebo at 9:00 PM on the night before surgery. The primary outcome of interest was the incidence of postoperative delirium (POD) within 3 days, assessed using the Confusion Assessment Method (CAM). Secondary outcomes included POD incidence within 7 days, delirium severity and duration, perioperative sleep quality, pain, anxiety, quality of recovery, time to ambulation, and adverse events. Outcomes were assessed up to 7 days postoperatively. Overall, the results revealed that intranasal dexmedetomidine significantly reduced POD incidence within 3 days compared with placebo (10.3% vs 20.7%) and improved perioperative sleep quality. These findings suggested that preoperative intranasal dexmedetomidine could offer a practical strategy for reducing delirium risk in older patients undergoing joint arthroplasty.