Abstract | Background:
Proximal femoral fractures (PrFF) are one of the most common causes of emergency admission in the elderly population. The majority of patients have pre-existing conditions that get worsened by unplanned surgery. Objective: Methods: The study was performed at a level II trauma center which is a part of a teaching hospital with a catchment population of around 300,000 patients, the first author's affiliation. Around 500 PrFF are performed yearly in the center. All participants gave oral and written informed consent before randomization. Results: In total, 60 patients with a PrFF, ASA status 2 or 3 were randomized into two groups for spinal anaesthesia as DLSA study group (received 8 mg of dexamethasone and 12.5 mg of 0.5 % levobupivacaine) or LSA control group (received 12.5 mg of 0,5 % levobupivacaine). Postoperative cognitive disturbance was evaluated using simplified Confusion Assessment Method (CAM) scale, pain intensity was measured using Visual Analogue Scale (VAS) and blood samples for defining cortisol concentrations were taken before and after the surgical procedure. The primary outcomes were effects of intrathecal dexamethasone on plasma cortisol affecting cognitive disturbances. Secondary outcomes included pain scores and length of hospital stay. The DLSA group demonstrated a reduced incidence of postoperative cognitive dysfunction (POCD), p=0.043, longer analgesia duration, p<0.001, decreased cortisol levels and shorter hospitalization p=0.045. Intrathecal dexamethasone was the only significant predictor of postoperative delirium, OR 7.76, p=0.019. Conclusion:
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Authors | Livija Sakic, Dinko Tonkovicc, Zlatko Hrgovic, Antonio Klasan |
Journal | Medical archives (Sarajevo, Bosnia and Herzegovina)
(Med Arch)
Vol. 77
Issue 1
Pg. 18-23
(Feb 2023)
ISSN: 1986-5961 [Electronic] Bosnia and Herzegovina |
PMID | 36919129
(Publication Type: Randomized Controlled Trial, Journal Article)
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Copyright | © 2023 Livija Sakic, Dinko Tonkovic, Zlatko Hrgovic, Antonio Klasan. |
Chemical References |
- Levobupivacaine
- Hydrocortisone
- Dexamethasone
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Topics |
- Humans
- Aged
- Levobupivacaine
- Hydrocortisone
- Cognition Disorders
- Cognitive Dysfunction
- Dexamethasone
(therapeutic use)
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