Effects of Perioperative Transauricular Vagus Nerve Electrical Stimulation on Postoperative Delirium, Postoperative Cognitive Dysfunction and Chronic Postsurgical Pain in Patients Undergoing Arthroplasty.
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Postoperative Cognitive Dysfunction
- Sponsor
- Xuzhou Central Hospital
- Enrollment
- 600
- Locations
- 1
- Primary Endpoint
- Postoperative cognitive function
- Status
- Not yet recruiting
- Last Updated
- 3 years ago
Overview
Brief Summary
Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) occur in 11-51% of patients after surgery, and its prevalence increases with age. The occurrence of delirium is associated with increased morbidity and mortality, prolonged hospital stay, worse functional recovery. Orthopedic procedures and specifically joint replacements have been considered as a major risk for development of chronic postsurgical pain (CPSP). Approximately 13-44% of patients will develop CPSP after knee or hip arthOpioid abuseroplasty. CPSP may cause the discomfort, distress, disability and opioid abuse. Mounting evidence has revealed that inflammation triggered by surgical trauma plays a key role in POD, POCD and CPSP. Recent studies found that vagus nerve stimulation showed the suppression of inflammation. In this study, the effect of perioperative transauricular vagus nerve stimulation on the prognosis of patients undergoing arthroplasty will be investigated, providing potential solutions for the prevention and treatment of postoperative cognitive dysfunction, postoperative delirium and chronic postsurgical pain.
Detailed Description
The investigators assessed POD by the Confusion Assessment Method for the ICU twice daily for 7 days after surgery. Participants' cognitive function was assessed with neuropsychological battery tests. The tests included digit span (forward and backward), Corsi block, paired associate verbal learning, digit symbol test, trail-making test and so on.The investigators make a CPSP diagnosis based on the 11th revision of the International Classification of Diseases.
Investigators
Eligibility Criteria
Inclusion Criteria
- •50 to 80 years old.
- •ASA grade I-Ⅲ.
- •elective knee or hip replacement.
Exclusion Criteria
- •Mini-Mental State Examination (MMSE) score \<
- •Education years\<
- •Peptic ulcer disease, serious cardiac-cerebral vascular disease.
- •Neurological or psychiatric disorders.
- •History of drug and alcohol abuse.
- •Hepatic and/or kidney dysfunction.
- •Patients on antidepressants.
Outcomes
Primary Outcomes
Postoperative cognitive function
Time Frame: 3 months after the surgery.
The incidence of POCD was compared between the experimental group and the control group.The preoperative and postoperative differences of the following scales were calculated and compared: Digit Span (forward and backward), Visual Retention and Paired Associate Verbal Learning subtests of the Wechsler Memory Scale, Digit Symbol subtest of the Wechsler Adult Intelligence ScaleRevised, Halstead-Reitan Trail Making Test (Part A), Corsi Block Test and Grooved Pegboard Test (favored and unfavored hand). The standard deviation (SD) for each test was computed from the preoperative scores. A participant whose postoperative performance declined by ≥1 SD as compared to each preoperative test score on ≥2 tests was classified as POCD.
Acute postoperative pain
Time Frame: Consecutive 7 days after the surgery for acute pain
The incidence of acute postoperative pain was compared between the experimental group and the control group.Acute postoperative pain was assessed by Visual Analogue Scale(VAS) for 7 consecutive days within 1 week after surgery.
Postoperative delirium
Time Frame: Consecutive 7 days after the surgery
The incidence of POD was compared between the experimental group and the control group.Postoperative delirium was assessed by the Delirium Assessment Scale (CAM-ICU)
Chronic Postsurgical pain
Time Frame: 3 months after the surgery for chronic pain
The incidence of chronic postoperative pain (CPSP) was assessed by the Short Form McGill Pain Questionnaire (SF-MPQ) and Neuropathic Pain Scale (NPS).The incidence of CPSP was compared between the experimental group and the control group.
Secondary Outcomes
- cortisol level in peripheral venous blood(1 day before the surgery, Postoperative day 1, 3, 5)
- TNF-α level in peripheral venous blood(1 day before the surgery, Postoperative day 1, 3, 5)
- IL-6 level in peripheral venous blood(1 day before the surgery, Postoperative day 1, 3, 5)
- IL-1β level in peripheral venous blood(1 day before the surgery, Postoperative day 1, 3, 5)