Effect of deep neuromuscular blockade on serum cytokines and postoperative delirium in elderly patients undergoing total hip replacement: A prospective single-blind randomised controlled trial

研究概要

Eighty-two elderly patients with hip fracture scheduled for a total hip replacement under general anesthesia were randomized to receive a deep neuromuscular blockade (n=41) or a moderate neuromuscular blockade (n=41) for the facilitation of tissue manipulation during surgery. Outcomes of interest included inflammatory markers (interleukin [IL]-1b; IL-6; tumour necrosis factor [TNF] alpha; IL-10), incidence of post-operative delirium, post-operative bleeding, pain at rest and during movement on a Visual Analogue Scale (VAS), incidence of post-operative nausea and vomiting, laboratory evaluation (hematocrit; lactate; PF ratio; albumin; creatinine; alanine transaminase; aspartate transaminase; C-reactive protein [CRP]), and the incidence of intensive care unit ICU) admission. Outcome assessment was performed up to 7 days post-operation. Results revealed statistically significantly lower post-operative bleeding up to post-operative day 2 in the deep blockade group compared to the control group (p=0.027). No statistically significant differences in the incidence of post-operative delirium (p=0.129), ICU admission (p=0.314), VAS pain scores at rest and during motion up to 72 hours post-operation (p>0.05 for all), and the incidence of post-operative nausea and vomiting up to 72 hours post-operation (p>0.05 for all) were observed between the two groups. Moreover, hematocrit levels at 24 hours post-operation, PF ratio immediately post-operation, and albumin levels at 48 hours post-operation were statistically significantly higher in the deep blockade group compared to the control group (p<0.05 for all). Moreover, IL-6 levels immediately post-operation and at 6 hours, and creatine phosphokinase levels at 6 and 24 hours post-operation, were statistically significantly lower in the deep blockade group (p<0.05 for all). Otherwise, no statistical significant differences in laboratory values were observed between the two groups (p>0.05 for all).