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ORIGINAL RESEARCH article

Front. Pharmacol.
Sec. Integrative and Regenerative Pharmacology
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1454452

Effects of dexmedetomidine-ropivacaine assisted combined spinal-epidural anesthesia on neutrophil-lymphocyte ratio and postoperative delirium in elderly patients with intertrochanteric femoral fracture

Provisionally accepted
Lili Bai Lili Bai *Lina Zhao Lina Zhao Fang Jia Fang Jia Ying Liu Ying Liu Ping Li Ping Li
  • Tianjin Hospital, Tianjin, China

The final, formatted version of the article will be published soon.

    Objective: Intertrochanteric femoral fracture (IFF) is a public issue in the old. Combined spinal-epidural anesthesia (CSEA) is commonly utilized for lower limb orthopedic surgery in elderly patients. Therefore, this study explored the application of dexmedetomidine (Dex) and ropivacaine (Rop) assisted CSEA in elderly IFF patients.: Totally 187 elderly IFF patients were assigned into the Rop assisted CSEA (Rop-CSEA), low-dose Dex-Rop assisted CSEA (low Dex & Rop-CSEA ) and high-dose Dex-Rop assisted CSEA (high Dex & Rop-CSEA) groups. We compared block effects, hemodynamic indicators [heart rate (HR)/respiratory rate (RR)/mean arterial pressure (MAP)] at time before anesthesia (T0)/skin incision (T1)/10 min postoperatively (T2)/suture postoperatively (T3)/anesthesia recovery (T4), postoperative pain mediator release [substance P (SP)/prostaglandin E2 (PGE2)/5-hydroxytryptamine (5-HT)], neutrophil-lymphocyte ratio (NLR), adverse reactions, delirium and cognitive dysfunction incidence. Results: Compared with the Rop-CSEA group, low/high Dex & Rop-CSEA groups had shortened onset times, prolonged recovery times in sensory/motor block, elevated HR/RR/MAP, repressed pain mediator release, and reduced postoperative delirium and cognitive dysfunction incidences. HR/RR/MAP exhibited reductions followed by elevations at T2-T4, and SP/PGE2/5-HT levels revealed elevations in all groups postoperatively. NLR level displayed enhancement followed by reduction, and NLR in the low/high Dex & Rop-CSEA groups was abated on postoperative days 1-5. Total incidence of adverse reactions in the high Dex & Rop-CSEA group was enhanced. Conclusions: Dex & Rop assisted CSEA shortens the onset time of anesthesia, maintains perioperative hemodynamic stability, inhibits pain mediator release, reduces postoperative NLR level and the incidence of delirium and cognitive dysfunction in IFF patients.

    Keywords: Intertrochanteric femoral fracture, Combined spinal epidural anesthesia, Dexmedetomidine, Ropivacaine, Neutrophil/lymphocyte ratio, Delirium, cognitive dysfunction, Hemodynamics

    Received: 25 Jun 2024; Accepted: 18 Dec 2024.

    Copyright: © 2024 Bai, Zhao, Jia, Liu and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Lili Bai, Tianjin Hospital, Tianjin, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.