Buccal Acupuncture for Delirium Treatment in Older Patients Recovering From Orthopedic Surgery

Buccal Acupuncture for Delirium Treatment in Older Patients Recovering From Orthopedic Surgery: a Randomized Controlled Trial

This study is designed to test the hypothesis that, for older orthopedic patients who developed postoperative delirium, combining buccal acupuncture with routine care will shorten delirium duration and relieve delirium severity.

Delirium is an acute, transient central nervous system dysfunction characterized by fluctuating disturbances of attention, consciousness, and cognitive function. Delirium is common in older patients following surgery. The incidence of postoperative delirium ranges from 12.0% to 23.8% in older patients; the incidence of delirium is about 10.7-17.6% in older patients after joint replacement surgery. The occurrence of delirium is associated with worse outcomes, including increased early postoperative complications, prolonged hospital-stay, and increased in-hospital mortality, as well as long-term decline in cognitive function, quality of life, and survival duration.

Clinical use of acupuncture has a long history in China. Buccal acupuncture therapy is a microneedle technique and provides treatment for systemic diseases by acupuncturing specific acupoints in the cheek. Acupuncture is also used for delirium treatment. Studies of older patients who developed delirium in internal medicine wards found that, compared with routine care alone, combining routine care with acupuncture relieved delirious symptoms and severity more efficaciously. However, evidence in this aspect is limited. We suppose that, for older orthopedic patients who developed postoperative delirium, combining buccal acupuncture with routine care will shorten delirium duration and relieve delirium severity.

Inclusion criteria:

• Aged ≥65 years, but <90 years.
• After knee or hip replacement surgery.
• Diagnosed with delirium in the morning of enrollment.

Exclusion criteria:

• Refuse to participate in the study.
• Presence of any contraindications to acupuncture, such as puncture site infections or platelet count ≤20×10^9/L.
• Preoperative history of schizophrenia, epilepsy, Parkinson's disease, or myasthenia gravis.
• Inability to communicate due to coma, profound dementia, or language barrier, or inability to cooperate with treatment due to agitation.
• American Society of Anesthesiologists physical status grade ≥V, or estimated survival ≤24 h.