Dexmedetomidine plus sufentanil cuts postoperative delirium risk to 4.9% vs 15.28% with sufentanil aloneCombining two drugs cuts confusion after lung surgery for older adults

OBJECTIVE: This study aimed to investigate the effect of intravenous (IV) patient-controlled anesthesia (PCA) combined with dexmedetomidine (DEX) injections on reducing the risk of postoperative delirium (POD) in elderly patients undergoing thoracoscopic lung surgery, hypothesizing a potential risk reduction. MATERIALS AND METHODS: Patients aged 65 years and older who underwent thoracoscopic lung surgery were assessed for eligibility. The participants were randomly assigned to either the test or control group. The test group received DEX through an IV PCA pump, consisting of 3 μg×kg sufentanil and 3 μg×kg DEX, while the control group received 3 μg×kg sufentanil. PCA parameters were standardized, including a total volume of 150 mL, a 2-mL bolus dose with a 15-minute lock-out period, and a background infusion rate of 2 mL/h. The primary outcome was the incidence of POD, which was evaluated twice daily for 7 days after surgery. The secondary outcomes included duration of POD, incidence of postoperative nausea and vomiting (PONV), postoperative hospitalization duration, pain assessment, and adverse events. RESULTS: A total of 287 patients were recruited. The incidence of POD in the control group was significantly higher (15.28 vs. 4.9%, p = 0.006). There were no significant differences in POD duration, PONV, or the length of hospital stay after operation between the two groups. The incidence of hypertension in the test group was significantly lower (p < 0.001), and no differences were found for other adverse events. CONCLUSION: IV patient-controlled DEX injections after major thoracoscopic lung surgery can reduce postoperative delirium.