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Hip fractures incidence grows rapidly with the aging of the population. After indicated surgical treatment, hip fracture patients experience high rates of postoperative complications, postoperative delirium (PD), postoperative cognitive dysfunction (POCD), leading to poor postoperative recovery during hospitalization, which can cause disability, distress for both patients and their families, are associated with other medical complications and account for significant additional health care costs. We currently use dexmedetomidine in elderly patients with hip fractures undergoing hip hemi-arthroplasty in order to improve postoperative recovery and prevent and treating PD and POCD.
Dexmedetomidine is a drug used for sedation in critically ill patients that provides some pain relief and controls the bodies response to stress. The sedation produced by dexmedetomidine appears more similar to natural sleep than any other drug used for anesthesia and postoperative sedation. Data suggesting that dexmedetomidine can prevent delirium following cardiac surgery and the developing understanding of the causes of PD and POCD suggest that dexmedetomidine will be particularly effective.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Dexmedetomidine | Active Comparator | Dexmedetomidine in dex group is administered as 1ug/kg by intravenous infusion 10 min and then 0.6 ug/kg until 30 minutes before the operation finishes. |
|
| Saline | Placebo Comparator | Participants in con group receive placebo(saline) as the same dose at the same time as dex group. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| hip arthroplasty | Procedure | Every patient with femoral neck fractures must undergo hip hemi-arthroplasty. |
|
| Measure | Description | Time Frame |
|---|---|---|
| postoperative cognitive dysfunction(POCD) | POCD is assessed by Montreal Cognitive Assessment(MoCA), which was designed as a rapid screening instrument for mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration,executive functions, memory, language,visuoconstructional skills, conceptual thinking,calculations, and orientation. Time to administer the MoCA is approximately 10 minutes. The total possible score is 30 points; a score of 26 or above is considered normal. | 7days |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative recovery | The postoperative recovery is assessed by the Post-operative Quality Recovery Scale (PQRS),which is a research tool designed to measure postoperative quality of recovery in multiple domains and over multiple time periods. Recovery domains include physiological, emotive (depression and anxiety), nociceptive (pain and nausea), cognitive, activities of daily living (ADL), and overall patient perspective (including satisfaction). |
| Measure | Description | Time Frame |
|---|---|---|
| postoperative complications | 7 days | |
| perioperative opioid consumption | Intraoperative and postoperative opioid consumption were calculated between the two groups. | 3 days |
Inclusion criteria
Exclusion Criteria
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| zhang hong, ph.d | Contact | 0086-10-66937462 | mazuimao301@yahoo.com.cn | |
| yuan weixiu, ph.d | Contact |
| Name | Affiliation | Role |
|---|---|---|
| zhang hong, ph.d | Anesthesia and Operation Center, Chinese People's Liberation Army General Hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Anesthesia and Operation Center, Chinese People's Liberation Army General Hospital | Recruiting | Beijing | 100853 | China |
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| Total Intravenous Anesthesia and Peripheral nerve blocks | Drug | Every patient receives Peripheral nerve blocks and Total Intravenous Anesthesia with propofol |
|
| 7days |
| Postoperative Delirium(PD) | The postoperative Delirium is assessed by the Confusion Assessment Method (CAM) | 72 hours |
| IL-6 and C-reacting protein | 7 days |
| MB isoenzyme of creatine kinase and blood sugar | 7 days |
| ID | Term |
|---|---|
| D005265 | Femoral Neck Fractures |
| D011183 | Postoperative Complications |
| D000071257 | Emergence Delirium |
| D000079690 | Postoperative Cognitive Complications |
| ID | Term |
|---|---|
| D006620 | Hip Fractures |
| D005264 | Femoral Fractures |
| D050723 | Fractures, Bone |
| D014947 | Wounds and Injuries |
| D025981 | Hip Injuries |
| D007869 | Leg Injuries |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D003693 | Delirium |
| D003221 | Confusion |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |
| D060825 | Cognitive Dysfunction |
| D003072 | Cognition Disorders |
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| ID | Term |
|---|---|
| D019644 | Arthroplasty, Replacement, Hip |
| ID | Term |
|---|---|
| D019643 | Arthroplasty, Replacement |
| D001178 | Arthroplasty |
| D019637 | Orthopedic Procedures |
| D013514 | Surgical Procedures, Operative |
| D019651 | Plastic Surgery Procedures |
| D019919 | Prosthesis Implantation |
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