Effect Of Reducing-opioids Consumption On Postoperative Delirium Incidence In Elderly Patients After Gastric Cancer Surgery

Objective: Postoperative delirium(POD)is a common postoperative complication in elderly patients,which brings great pain and burden to patients and their families.Opioids are conventional anesthesia induction and analgesic drugs in the perioperative period,but studies have shown that they can cause postoperative delirium.This study aims to explore the effect of less opioids on the incidence of postoperative delirium in elderly patients undergoing gastric cancer surgery,so as to provide better perioperative anesthesia and postoperative analgesia for the prevention and treatment of postoperative delirium.Methods: In this study,130 elderly patients who met the inclusion criteria for limited gastric cancer surgery from July 2016 to September 2021 were selected in Zhejiang Cancer Hospital with the approval of the ethics committee of Cancer Hospital Affiliated to University of Chinese Academy of Sciences(Zhejiang Cancer Hospital).According to the random number table method,they were divided into conventional opioid general anesthesia group(group A)and minimal opioid general anesthesia group(group B).All patients received epidural anesthesia at the 8th to 10 th spinal segment of the chest before general anesthesia.Postoperative analgesic pump formula was as follows: Group A: 0.2%ropivacaine +1μg/ml sufentanil solution;Group B: 0.2% ropivacaine solution.Within 3days after operation,POD was assessed once every day between 8:00 am and 8:00 PM according to Richmond agitation and VAS score and Intensive care unit(ICU)ambiguity assessment method,and relevant physiological indicators were recorded.The primary outcome measure was the incidence of POD at 3 days after surgery,and the secondary outcome measures included the pain score at 3 days after surgery,anaesthesia related adverse events,such as nausea and vomiting,postoperative fever and fatigueResults: Among the 130 enrolled patients,7 patients were excluded because they did not cooperate to complete the POD test after operation.Finally,123 elderly patients completed the study,59 cases in group A and 64 cases in group B.There were no differences in demographic data and intraoperative conditions between the two groups(all P >0.05).The total incidence of POD 3 days after operation in group A and group B was30.5%(18/59)and 18.8%(12/64),respectively,and there was no significant difference(P>0.05).However,the incidence of POD at 48 and 72 h after operation in group A [27.1%(16/59),16.9%(10/59)] was higher than that in group B [10.9%(8/64),4.7%(3/64),all P<0.05].The incidence of fatigue in group A was lower than that in group B(group A:25.4%(15/59)vs.64.1%(41/64),P<0.0001),but the incidence of nausea and vomiting in group A was higher than that in group B [15.3%(9/59)vs.1.6%(1/64),P<0.05].Conclusion: Reducing-opioids consumption have no effect on the incidence of total POD 3 d after gastric cancer surgery in elderly patients,but can reduce the risk of POD48-72 h after surgery.