Influence of Parecoxib combined with Morphine on delirium incidence in elderly patients

Abstract

Objectives To investigate the influence of multimodel analgesia of Parecoxib combined with Morphine on delirium in elderly patients. Methods Patients aged 60-85 years scheduled for thoracic surgery, general surgery or orthopedic surgery were randomized into Parecoxib combined with Morphine group(PM group)or Morphine alone group(M group). All patients in two groups received the same regimen of Morphine for patient controlled intravenous analgesia(PCIA)after operation.Patients in PM group received the first dose of Parecoxib 40 mg at the end of surgery, and then received parecoxib 40 mg per dose at 12-hour interval until postoperative 72 hours.Patients in M group received normal saline instead of Parecoxib.Incidence rate of delirium was evaluated during 1st to 5th postoperative day(confusion assessment method for the intensive are unit). The visual analogue score(VAS), daily morphine consumption, presence of nausea and vomiting(PONV), Blood urea nitrogen, serum creatinine, alanine aminotransferase, aspartate aminotransferase, prothrombin time, activated partial throboplastin time, and international normallized ratios on 1st to 3rd postoperative day were recorded and compared between the two groups. Results The delirium incidence during 5 days after operation was 4.3%(11/257)in PM group, and 6.8%(17/250)in morphine alone group(P>0.05). From 1st to 3rd postoperative day, PM group versus M group showed that VAS was lower(P<0.01), consumption of Morphine was lower(P<0.05), incidence of PONV was lower(P<0.05). Conclusions Parecoxib combined with morphine used in the elderly patients improves postoperative analgesia, reduces morphine consumption and incidence of PONV, but has no significant effect on delirium incidence. Key words: Abortifacient agents, nonsteroidal; Delirium; Analgesia