http://www.frontiersin.org/neuroscience/agingneuroscience/paper/10.3389/fnagi.2010.00024/

Vollständiger Abstract

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<h4>Background</h4>Postoperative delirium (POD) is a common and serious complication in elderly patients undergoing diabetic foot surgery, often linked to excessive opioid use and systemic neuroinflammation. This study aimed to evaluate whether ultrasound-guided nerve block (NB) reduces the incidence of POD compared to general anesthesia (GA) in this high-risk population.<h4>Methods</h4>We conducted a propensity score-matched (PSM) retrospective cohort study involving 137 patients. The primary outcome was the incidence of POD, while secondary outcomes included intraoperative opioid consumption (sufentanil equivalent) and postoperative interleukin-6 (IL-6) levels. Standardized mean differences (SMDs) were used to assess covariate balance after matching.<h4>Results</h4>After PSM, the incidence of POD was significantly lower in the NB group (5.6%) than in the GA group (25.0%, <i>P</i> = 0.046). NB significantly reduced intraoperative sufentanil requirements (<i>P</i> < 0.001) and suppressed the elevation of IL-6 at 24 h postoperatively (<i>P</i> < 0.001). The protective association with NB was directionally consistent across crude, multivariable-adjusted, and matched analyses. No significant differences were observed in postoperative CRP levels or length of hospital stay (<i>P</i> > 0.05).<h4>Conclusion</h4>Ultrasound-guided NB is associated with a lower POD risk in elderly patients with diabetic foot, consistent with potential mediation through opioid-sparing and anti-inflammatory mechanisms.

Abstract: PubMed · Datensatz