Can Postoperative or Preemptive Epidural Analgesia Affect the Incidence of Postoperative Delirium After Major Abdominal Surgery?

Objectives: The study aimed to investigate the effects of postoperative and preemptive epidural analgesia combined with total intravenous anesthesia (TIVA) on the incidence of postoperative delirium (POD) in patients undergoing major abdominal surgery for >= 4 h. Methods: In this prospective randomized study, after evaluating 158 patients, 110 patients who were more than 50 years old were divided as follows: Group A, which received postoperative epidural analgesia (n=57), and Group B, which received preemptive epidural analgesia (n=54) combined with TIVA. Before and after surgery, delirium was diagnosed using the Mini-Mental State Examination, Confusion Assessment Method, and writing test. Risk factors for delirium were determined. Results: The overall incidence of delirium was 8.1% (9/110). POD was seen in five patients in Group A and four patients in Group B. The mean age of patients diagnosed with POD was 67.3 +/- 4.1 years, and this was greater than that of the remaining study patients (p=0.001). The average time until the onset of delirium was 2.2 +/- 0.8 days, and the mean duration of delirium was 6.3 +/- 4.2 days; however, there were no significant differences when comparing Group A patients with Group B patients in terms of these parameters (p>0.05). Significant risk factors for the development of delirium were old age, previous history of chronic obstructive pulmonary disease, male sex, being single, and excess smoking (p<0.001). Conclusion: Older patients showed POD within the first 3 days after undergoing major abdominal surgery. The incidence of delirium was not different between the patients who received postoperative epidural analgesia and those who received preemptive epidural analgesia combined with TIVA.