The effect of celecoxib on early postoperative cognitive dysfunction in elderly patients of fracture neck of femur: a prospective randomised double-blind study

Abstract

Background: 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. Key words: Postoperative cognitive dysfunction; Celecoxib; NRS; Elderly patients; MMSE; Neuropsychological Tests; neuroinflammation Abbreviations: POCD – Postoperative cognitive dysfunction; COX-2 – cyclooxygenase-2; MMSE – Mini Mental State Examination; BMI – Basal metabolic rate; NRS – Numerical Rating Scale Citation: Dixit P, Singh V, Verma S, Singh GP, Singh MK, Kumar S. The effect of celecoxib on early postoperative cognitive dysfunction in elderly patients of fracture neck of femur: a prospective randomised double-blind study. Anaesth. pain intensive care 2021;25(3):287–294. DOI: doi.org/10.35975/apic.v25i3.1519 Received: April 5, 2020; Reviewed: May 19, 2021; Revised: June 27, 2021; Accepted: June 27, 2020