Effect of regional anesthesia on the postoperative delirium: A systematic review and meta-analysis of randomized controlled trials

Abstract

ObjectivePostoperative delirium (POD) starts in the recovery room and occurs up to 5 days after surgery. However, the POD guidelines issued by the European Society of Anesthesiology (ESA) suggest that the effect of regional anesthesia on POD is controversial. This meta-analysis aims to investigate whether perioperative regional anesthesia reduced the incidence of POD.MethodsStandard Published randomized controlled trails (RCTs) were searched from bibliographic databases to identify all evidence that reported regional anesthesia assessing incident delirium following diverse surgeries. The primary outcome was the incidence of POD, and the secondary outcomes were POD scores, pain scores, and emergence time. The relative risk (RR) for dichotomous outcomes and the weighted or standardized mean difference (WMD, SMD) for continuous outcomes were estimated using a random-effects model.ResultsTwenty RCTs with 2110 randomized participants undergoing different surgeries were included. Meta-analysis showed that regional anesthesia was associated with less POD incidence compared to general anesthesia (total intravenous anesthesia (TIVA) or inhalation anesthesia) (relative risk (RR) = 0.62, 95% confidence interval (CI) = 0.45–0.85)). Subgroup analysis showed that the decrease in POD incidence was associated with a nerve block (0.46, 95% CI = 0.32–0.67) and regional-combined-general anesthesia (0.42, 95% CI = 0.29–0.60). Regional anesthesia significantly reduced POD incidence in the recovery room after pediatric surgeries (0.41, 95% CI = 0.29–0.56). Regional anesthesia also reduced the POD score (SMD −0.93, 95% CI = −1.55 to −0.31) and pain score (SMD −0.95, 95% CI = −1.72 to −0.81). There was no significant difference in emergence time between regional anesthesia and general anesthesia (WMD −1.40, 95% CI = −3.83 to 6.63).ConclusionsThere was a significant correlation between regional anesthesia and the decrease in POD incidence, POD score, and pain score.

The Effect of Peripheral Nerve Block on Postoperative Delirium in Older Adults Undergoing Hip Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Li et al [ 48 ] also examined the effects of nerve blocks on postoperative neurological changes via a meta-analysis. The authors of this meta-analysis placed no restrictions on the type of surgery or age of participants, and included not only peripheral nerve blocks, but also neuraxial blocks, such as spinal anesthesia or caudal blocks, which were excluded in our study.…”

Incidence and predictors of hemodynamic compromise due to high-grade AV block after TAVI

“…The transapical access route was also more frequently used in our HC subgroup. The reasons for this association are diverse: patients undergoing TAVI via the transapical access route require general anesthesia, which is generally associated with a higher postprocedural rate of delirious states compared with rates for local anesthesia ( 35 ), which can usually be applied during a transfemoral TAVI approach. Also, transapical access is only used when transfemoral access is not feasible, most likely due to more severe peripheral artery disease, which also might reflect a higher comorbidity burden that in turn is associated with a higher incidence of delirium.…”

Associations of postoperative delirium with activities of daily living in older people after major surgery: A prospective cohort study

“…It should be acknowledged that the main aim of the study was changes in the ability to perform ADL independently in the immediate postoperative period in relation to a new episode of delirium, thus, patients with preoperative delirium were excluded. Furthermore, although general and regional anaesthesia are associated with the development of postoperative delirium it was reported in a recent systematic review that regional anaesthesia contributes to reducing postoperative delirium (Li et al, 2022). We excluded patients who had a regional anaesthesia as the main aim of the study was to investigate changes in the ability to perform ADL independently in the immediate postoperative period in relation to the new onset of delirium.…”