Key result
Patient-controlled analgesia with fentanyl resulted in less depression in postoperative cognitive function than morphine, with no significant difference in clinical confusion.
Why the study?
Does patient-controlled analgesia with fentanyl improve postoperative cognitive function and reduce complications compared to morphine in elderly patients following hip or knee arthroplasty?
RCT (n=96)
Does patient-controlled analgesia with fentanyl improve postoperative cognitive function and reduce complications compared to morphine in elderly patients following hip or knee arthroplasty?
In elderly postoperative arthroplasty patients, patient-controlled analgesia with fentanyl results in less cognitive depression and urinary retention compared to morphine, though clinical confusion rates are not statistically different.
Answers are grounded in this paper and cite their sources.
May favor fentanyl PCA to limit postoperative cognitive effects; hypothesis-generating and requires randomized confirmation before practice change.
This study evaluated the safety and cognitive impact of patient-controlled analgesia with fentanyl compared to patient-controlled analgesia with morphine among elderly postoperative patients. In addition, two screening tests for cognitive impairment, the Mini Mental Status Exam and the Short Portable Mental Status Questionnaire, were compared. Ninety-six elderly patients were randomly allocated to receive patient-controlled analgesia with either fentanyl or morphine following hip or knee arthroplasty. Patients were evaluated postoperatively for clinical confusion, cognitive function test results, adequacy of analgesia, drug use and complications. Fentanyl produced less depression in postoperative cognitive function compared to morphine. The incidence of clinical confusion was not statistically different between groups (4.3% for fentanyl versus 14.3% for morphine). Fentanyl patients used more opioid based on a dose ratio of 100:1 suggesting that this dose ratio is inadequate. The incidence of urinary retention was lower in the fentanyl group. A poor agreement between the two tests of cognitive impairment mandates caution when peri-operative cognitive function is compared using different tests.
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Herrick et al. (1996) conducted an RCT in Postoperative pain following hip or knee arthroplasty (n=96). Patient-controlled analgesia with fentanyl vs. Patient-controlled analgesia with morphine was evaluated on clinical confusion (p=not statistically different). Patient-controlled analgesia with fentanyl resulted in less depression in postoperative cognitive function than morphine, with no significant difference in clinical confusion.
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