Efficacy Of Prophylactic Parecoxib On Postoperative Delirium In Elderly Orthopaedic Patients

Objective: To evaluate the effect of prophylactic administration of parecoxib sodium on postoperative delirium in elderly orthopedic patients.Methods: In this prospective,single-center,randomized,double-blind,placebocontrolled trial,a total of 109 elderly orthopedic patients were included,from June to December 2019,admitted to a hospital.Patients were randomly divided into placebo group(group A)and parecoxib sodium group(group B)with normal saline and parecoxib sodium 40 mg given respectively before operation.Delirium was evaluated by the confusion assessment method Chinese version(CAM-CR).The main outcomes were the incidence of delirium within 48 hrs after operation,the average delirium and average pain scores.The secondary outcomes measured from changes of laboratory indicators before and 1 day after operation,including white blood cells count(WBC),neutrophil percentage(NEUT%),platelet count(PLT),C-reactive protein change(CRP),cardiac troponin I level(CTn I),and incidence of adverse events(gastrointestinal hemorrhage,cardiovascular events,wound infection occured in 48 hrs.The follow-up outcome was measured by the actiitiy of daily life(ADL)after 60 days.Results: Finally,36 of 109 patients developed POD(33%),of which the incidence of group B was significantly lower than that of group A(43.8% vs.21.2%,p = 0.015).The average delirium scores and pain scores of group B were lower than that of group A(p < 0.05).Under the nonparametric test,significance only could be found in WBC change value compared group A with group B(0.63 ± 2.99 vs.-0.59 ± 3.08,p = 0.038);after eliminating some cases with large dispersion,the difference in changes of WBC,CRP and NEUT% between the two groups could be intuitively displayed by box plot.There was no significant difference in the changes of PLT anf CTn I between the two groups,and no adverse events occurred in the both two groups.There was no significant difference in ADL scores between the two groups(60.49 ± 20.26 vs.67.56 ± 14.56,p= 0.056),but the ADL scores of patients with POD was significantly lower than that of patients without POD(56.86 ± 19.78 vs.67.79 ± 15.85,p = 0.004).Conclusion: Prophylactic administration of parecoxib can effectively reduce the incidence of postoperative delirium in elderly orthopedic patients.