In elderly people recovering from orthopedic surgery, supplementation of intravenous analgesia with low-dose dexmedetomidine didn't considerably decrease delirium. However, it led to improvements in postoperative analgesia and subjective sleep quality without triggering adverse events.

This double-blinded, placebo-controlled, randomized controlled trial assessed whether supplementing sufentanil intravenous analgesia with dexmedetomidine minimizes delirium in older people (aged 65–90 years) recovering from major orthopedic surgery.

The study recruited 712 participants scheduled for major orthopedic surgery. Postsurgery analgesia was offered by patient-controlled intravenous sufentanil, supplemented by randomly allocated dexmedetomidine (1.25 μg/mL, n=356) or placebo (n=356), for up to 3 days. The occurrence of delirium evaluated twice daily using Confusion Assessment Method was the major endpoint.

Considering secondary outcomes, the severity of pain was evaluated twice daily and sleep quality once daily, each with an 11-point scale [0 representing no pain/best possible sleep and 10 representing worst pain/worst possible sleep.

Table 1 shows the occurrence of postoperative delirium in the study groups (relative risk 0.65, 95% Confidence Interval 0.36 to 1.18):

Dexmedetomidine was found to minimize pain both at rest (median difference -1 to 0 points) and with movement (-1 points) throughout the initial five postsurgery days. Furthermore, an improvement in the subjective sleep quality was noted during the initial three postsurgery days. Both the groups illustrated comparable occurrences of adverse events.

Dexmedetomidine remains an appropriate supplement for multimodal analgesia in older patients undergoing orthopedic surgery as it is associated with improvements in analgesia and quality of sleep.