IBUPROFEN AND POSTOP DELIRIUM
Abstract
Depending on the surgical procedure performed, the incidence of postoperative delirium is a staggering 15%-50% (Central Nervous System Risk Assessment: Preventing Postoperative Brain Injury. 2, 2022). Hence, any drug that can be administered to decrease this risk would be most beneficial. If it is inexpensive and readily available, all the better. In a recent meta-analysis, Narinder P. Singh et al. proved that there may be a beneficial effect of perioperative corticosteroids in postoperative neurocognitive deficits, though subgroup analysis showed a beneficial effect in postoperative delirium, but not in delayed neurocognitive recovery. However, the requisite information for a complete analysis and optimal subsample size is still deficient. Hence, the search for inexpensive drugs that can prevent postoperative delirium is still on.
Enter NSAIDs! In a recent meta-analysis of eight studies involving 1,238 participants, published in the Korean Journal of Anesthesiology, Kim et al. found that the incidence of postoperative delirium was 11% and 19% in the NSAID and control groups, respectively, with a significant reduction in the NSAID group (OR: 0.54, 95% CI [0.38, 0.7], P=0.0001, I2=0%). They found that NSAID use had a significant effect on postoperative pain reduction as well (MD: –0.75, 95% CI [–1.37, –0.13], P=0.0172, I2=88%). Significant lower postoperative opioid consumption was observed in the NSAID group (MD: –2.88, 95% CI [–3.54, –2.22], P=0.0000; I2=0%) (Korean J Anesthesiol 2024;77:546-54). This is also corroborated by a recent review presented at the ASA annual meeting in October 2024 by Steven M. Frank, MD et al. The authors went one step further, with the analysis being done in the crucial age group of >65 years separately. In that age group, non-salicylate NSAIDs were compared with acetaminophen in a total of 72,130 patients, with 36,065 patients in each group. Overall, patients in this age group who were given non-salicylate NSAIDs had a 33% lower risk for postoperative delirium than those given acetaminophen (asamonitor.pub/3NTXZ6Q).
Why it matters
The researchers went on to compare non-salicylate NSAIDs with salicylate NSAIDs, and they included a total of 24,960 patients, with 12,480 patients in each group. Overall, patients in this age group who were given non-salicylate NSAIDs had a 45% lower risk for postoperative delirium than those given salicylate NSAIDs. In conclusion, Dr. Frank stated, “Recent studies show acetaminophen helps reduce the risk of postoperative delirium, but our study is the largest to show non-salicylate NSAIDs like ibuprofen could be even better at reducing this risk.” Indeed, these two studies offer an inexpensive way to decrease one of the major complications of anesthesia: postoperative delirium.