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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.

Last updated: Aug 26, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score44/100
Human RCT★★☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. 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.

observational

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 · Drug design, development and therapy (2026)

Participants: N/A
Duration: Follow-up from admission to 7 days after surgery
Intervention: Intranasal dexmedetomidine (100 μg total dose) administered at 21:00 on the night before surgery
Outcome: Incidence of postoperative delirium within 3 days (primary), also within 7 days, sleep quality, anxiety, pain, quality of recovery, time to ambulation, adverse events
Effect Size: Relative risk = 0.50 (95% CI 0.26-0.95)
Population: Older patients (aged ≥60 years) with ASA status 1-3 undergoing total hip or knee arthroplasty under general anesthesia

Result:

PubMed: 42630921DOI: 10.2147/DDDT.S619935

Mechanism Graph

Intranasal dexmedetomidine administered preoperatively
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Improves perioperative sleep quality
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Reduces preoperative and postoperative anxiety and pain
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Results in reduced postoperative delirium incidence

Limitations

  • ⚠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.

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References

  1. 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
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.