The effect of celecoxib on early postoperative cognitive dysfunction in elderly patients of fracture neck of femur: a prospective randomised double-blind study | [Anaesthesia, Pain and Intensive Care • 2021]

Author(s):

1. Priya Dixit: Department of Anesthesiology, King George Medical University (KGMU),Lucknow, UP,India

2. Vinita Singh: Department of Anesthesiology, King George Medical University (KGMU),Lucknow, UP,India

3. Sateesh Verma: Department of Anesthesiology, King George Medical University (KGMU),Lucknow, UP,India

4. Manish Kumar Singh: Department of Anesthesiology, King George Medical University (KGMU),Lucknow, UP,India

5. Santosh Kumar: Department of Orthopedics, King George Medical University (KGMU),Lucknow, UP,India

6. Gyan Prakash Singh: Department of Anesthesiology, King George Medical University (KGMU), Lucknow, UP, India

Abstract:

Inflammation and postoperative pain plays an important role in the causation of postoperative cognitive dysfunction (POCD). Celecoxib - a COX-2 inhibitor, because of its anti-inflammatory and analgesic effects is used for the treatment of acute pain. In this study, we evaluated the effects of celecoxib on POCD and the postoperative pain in the elderly patients undergoing surgical reduction of fracture neck of femur under spinal anesthesia. Methodology: We enrolled 84 patients of either sex, age more than 65 y, ASA grade I to III, who were planned for surgical reduction of fracture neck femur under spinal anesthesia. The patients were randomly divided into two groups and treated with either celecoxib (Group-A) or placebo (Group-B) for one week starting from one day before surgery. Mini-Mental State Examination (MMSE) was done at one day before the surgery and at day seven after surgery. POCD was diagnosed if MMSE score was below 24 (out of 30). Numerical rating scale (NRS) was used to measure pain intensity one day before surgery and at postoperative days one, three and seven. The results were analysed using descriptive statistics and making comparisons among various groups. Results: MMSE at day 1 was 25.74 ± 1.45 vs. 26.45 ± 1.56 (p = 0.033) in Group-A and Group-B respectively. At postoperative day 7 it was 26.45 ± 1.56 vs. 23.64 ± 2.13 (p < 0.001) in Group-A and B respectively. NRS scores at postoperative day 1, 3 and 7 were 3.26 ± 1.43 vs. 3.62 ± 0.82 (p = 0.165), 3.38 ± 0.66 vs. 2.93 ± 0.68 (p = 0.003) and 1.19 ± 0.71 vs. 31 ± 0.72 (p = 0.445) in Group-A and Group-B respectively. Conclusion: The results of our study conclude that celecoxib decreases the incidence of early postoperative cognitive dysfunction (POCD) in elderly patients undergoing surgical reduction of fracture neck of femur under spinal anesthesia. The administration of celecoxib also decreases intensity of the pain among patients in this surgical setting during recovery period especially on day 3.

Page(s): 287-294

DOI: 10.35975/apic.v25i3.1519

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 25, Issue: 2, Year: 2021

Keywords:

Neuroinflammation , MMSE , NRS , Postoperative cognitive dysfunction , Elderly patients , Neuropsychological Tests , Celecoxib

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