Delirium After Fast-track Hip and Knee Arthroplasty
Delirium After Fast-track Hip and Knee Arthroplasty
We enrolled 225 patients in the study. Eighty-four patients declined to participate and stated the inconvenience of extra hospital visits as the reason. Two patients were excluded due to an MMSE score of <24. Patient characteristics and co-morbidities are listed in Table 3. Eighty-one patients had TKA and 144 THA. None had bilateral surgery. No patients were lost to follow-up during hospitalization, but five patients, who declined to participate in the postoperative follow-up due to the inconvenience of another hospital visit, were contacted by telephone after discharge.
Eighteen patients received opioids before operation (tramadol 50 mg three to four times per day).
Spinal anaesthesia was used in 203 (90.2%) patients, and 101 (49.7%) of these received propofol sedation, the total mean dose being 2.17 mg kg (range 0.24–6.98 mg kg, IQR 1.45–2.71 mg kg). Twenty-two patients (9.8%) received general anaesthesia; nine of these received total i.v. anaesthesia with propofol (mean 12.5 mg kg) and remifentanil (mean 0.062 mg kg) and 13 patients received volatile anaesthesia.
A total of 18.6% (n=42) patients were managed without rescue opioids. The remaining patients received small doses of a supplemental oral opioid either with oxycodone, morphine, or ketobemidone (Table 4). Twenty-nine patients needed both oxycodone and morphine to manage their pain after operation. Ten patients received sleep medication (Zolpidem® or Zipoclone®) while in hospital. No other sedatives were administered.
Eighteen patients received opioids before operation (tramadol 50 mg three to four times per day).
Spinal anaesthesia was used in 203 (90.2%) patients, and 101 (49.7%) of these received propofol sedation, the total mean dose being 2.17 mg kg (range 0.24–6.98 mg kg, IQR 1.45–2.71 mg kg). Twenty-two patients (9.8%) received general anaesthesia; nine of these received total i.v. anaesthesia with propofol (mean 12.5 mg kg) and remifentanil (mean 0.062 mg kg) and 13 patients received volatile anaesthesia.
A total of 18.6% (n=42) patients were managed without rescue opioids. The remaining patients received small doses of a supplemental oral opioid either with oxycodone, morphine, or ketobemidone (Table 4). Twenty-nine patients needed both oxycodone and morphine to manage their pain after operation. Ten patients received sleep medication (Zolpidem® or Zipoclone®) while in hospital. No other sedatives were administered.
Results
We enrolled 225 patients in the study. Eighty-four patients declined to participate and stated the inconvenience of extra hospital visits as the reason. Two patients were excluded due to an MMSE score of <24. Patient characteristics and co-morbidities are listed in Table 3. Eighty-one patients had TKA and 144 THA. None had bilateral surgery. No patients were lost to follow-up during hospitalization, but five patients, who declined to participate in the postoperative follow-up due to the inconvenience of another hospital visit, were contacted by telephone after discharge.
Eighteen patients received opioids before operation (tramadol 50 mg three to four times per day).
Spinal anaesthesia was used in 203 (90.2%) patients, and 101 (49.7%) of these received propofol sedation, the total mean dose being 2.17 mg kg (range 0.24–6.98 mg kg, IQR 1.45–2.71 mg kg). Twenty-two patients (9.8%) received general anaesthesia; nine of these received total i.v. anaesthesia with propofol (mean 12.5 mg kg) and remifentanil (mean 0.062 mg kg) and 13 patients received volatile anaesthesia.
A total of 18.6% (n=42) patients were managed without rescue opioids. The remaining patients received small doses of a supplemental oral opioid either with oxycodone, morphine, or ketobemidone (Table 4). Twenty-nine patients needed both oxycodone and morphine to manage their pain after operation. Ten patients received sleep medication (Zolpidem® or Zipoclone®) while in hospital. No other sedatives were administered.
Eighteen patients received opioids before operation (tramadol 50 mg three to four times per day).
Spinal anaesthesia was used in 203 (90.2%) patients, and 101 (49.7%) of these received propofol sedation, the total mean dose being 2.17 mg kg (range 0.24–6.98 mg kg, IQR 1.45–2.71 mg kg). Twenty-two patients (9.8%) received general anaesthesia; nine of these received total i.v. anaesthesia with propofol (mean 12.5 mg kg) and remifentanil (mean 0.062 mg kg) and 13 patients received volatile anaesthesia.
A total of 18.6% (n=42) patients were managed without rescue opioids. The remaining patients received small doses of a supplemental oral opioid either with oxycodone, morphine, or ketobemidone (Table 4). Twenty-nine patients needed both oxycodone and morphine to manage their pain after operation. Ten patients received sleep medication (Zolpidem® or Zipoclone®) while in hospital. No other sedatives were administered.
