Intranasal dexmedetomidine on the night before surgery reduces postoperative delirium incidence in older patients undergoing total hip or knee arthroplasty
In a randomized, double-blind, placebo-controlled trial, 232 older patients (≥60 years) undergoing total hip or knee arthroplasty received either intranasal dexmedetomidine (100 μg total dose) or normal saline at 21:00 the night before surgery. The incidence of postoperative delirium within 3 days was 10.3% in the dexmedetomidine group versus 20.7% in the placebo group (relative risk = 0.50; 95% CI = 0.26-0.95; P = 0.030). The intervention also improved perioperative sleep quality and reduced anxiety and pain, with no severe adverse events.
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Intranasal dexmedetomidine on the night before surgery reduces postoperative delirium incidence in older patients undergoing total hip or knee arthroplasty The current body of evidence comprises 1 study, including 1 randomized controlled trial. EvidenceHub rates the overall confidence at 44/100 (low).
The Claim
Intranasal dexmedetomidine on the night before surgery reduces postoperative delirium incidence in older patients undergoing total hip or knee arthroplasty
This conclusion is most relevant to: Older patients (aged ≥60 years) with ASA status 1-3 undergoing total hip or knee arthroplasty under general anesthesia.
What the Research Shows
The conclusion draws on 1 linked study. Highlights from the cited literature:
- ▸Effect of Intranasal Dexmedetomidine on the Night Before Surgery for Postoperative Delirium in Older Patients Undergoing Total Hip or Knee Arthroplasty: A Randomized Clinical Trial. (Drug design, development and therapy, 2026) —
How It Works
The proposed biological pathway:
- ▸Intranasal dexmedetomidine administered preoperatively
- ▸Improves perioperative sleep quality
- ▸Reduces preoperative and postoperative anxiety and pain
- ▸Results in reduced postoperative delirium incidence
Who Might Benefit
Evidence fit by population:
- ▸Older patients (aged ≥60 years) with ASA status 1-3 undergoing total hip or knee arthroplasty under general anesthesia
Recommended Dose
100 μg intranasal dexmedetomidine
Limitations & Caveats
Important context when interpreting this evidence:
- ▸Single-center trial conducted at one tertiary academic hospital in China, limiting generalizability
- ▸Short follow-up period (7 days post-surgery) may not capture longer-term delirium outcomes
- ▸Potential unmeasured confounding factors (e.g., baseline cognitive status, medication use) not fully addressed in abstract
Frequently Asked Questions
What is the recommended dose of intranasal dexmedetomidine for delirium prevention?▼
The study used a total dose of 100 μg intranasal dexmedetomidine administered at 21:00 on the night before surgery.
How does intranasal dexmedetomidine reduce postoperative delirium?▼
The study suggests that improved sleep quality, along with reduced anxiety and pain, may partly explain the reduction in delirium incidence.
Is intranasal dexmedetomidine safe in older patients?▼
No severe adverse events or nasal mucosal injuries were observed in either group, indicating it was well tolerated in this older population.
What was the incidence of delirium in the placebo group?▼
The placebo group had a 20.7% incidence of postoperative delirium within 3 days, compared to 10.3% in the dexmedetomidine group.
References
- 1.Liu Y, Wang K, Zhang Y, Zhang Z, Yin T, Chen Y, Wang C, Chen W, Zhang M, Zhao L, Wu Y, Sun J, Liu S. “Effect of Intranasal Dexmedetomidine on the Night Before Surgery for Postoperative Delirium in Older Patients Undergoing Total Hip or Knee Arthroplasty: A Randomized Clinical Trial..” Drug design, development and therapy, 2026. PMID: 42630921 DOI: 10.2147/DDDT.S619935