Background: The effect of peripheral nerve blocks on postoperative delirium in older patients has not been\r\nstudied. Peripheral nerve blocks may reduce the incidence of postoperative opioid use and its side effects such as\r\ndelirium via opioid-sparing effect.\r\nMethods: A prospective cohort study was conducted in patients who underwent total knee replacement. Baseline\r\ncognitive function was assessed using the Telephone Interview for Cognitive Status. Postoperative delirium was\r\nmeasured using the Confusion Assessment Method postoperatively. Incidence of postoperative delirium was\r\ncompared in two postoperative management groups: femoral nerve block �± patient-controlled analgesia and\r\npatient-controlled analgesia only. In addition, pain levels (using numeric rating scales) and opioid use were\r\ncompared in two groups.\r\nResults: 85 patients were studied. The overall incidence of postoperative delirium either on postoperative day one\r\nor day two was 48.1%. Incidence of postoperative delirium in the femoral nerve block group was lower than\r\npatient controlled analgesia only group (25% vs. 61%, P = 0.002). However, there was no significant difference\r\nbetween the groups with respect to postoperative pain level or the amount of intravenous opioid use.\r\nConclusions: Femoral nerve block reduces the incidence of postoperative delirium. These results suggest that a\r\nlarger randomized control trial is necessary to confirm these preliminary findings.
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