The Role of Postoperative Analgesia in Delirium and Cognitive Decline in Elderly Patients: A Systematic Review

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Abstract
Postoperative delirium and cognitive decline are ad- verse events that occur frequently in elderly patients. Preexisting patient factors, medications, and various intraoperative and postoperative causes have been im- plicated in the development of postoperative delirium and cognitive decline. Despite previous studies identi- fying postoperative pain as a risk factor, relatively few clinical studies have compared the effect of common postoperative pain management techniques (IV and epidural) or opioid analgesics on postoperative cogni- tive status. A systematic search of the PubMed and CI- NAHL databases identified six studies comparing dif- ferent opioid analgesics on postoperative delirium and cognitive decline and five studies comparing IV and epiduralroutesofadministeringanalgesia.Meperidine was consistently associated with an increased risk of deliriuminelderlysurgicalpatients,butthecurrentev- idencehasnotshownasignificantdifferenceinpostop- erativedeliriumorcognitivedeclineamongothermore frequently used postoperative opioids such as mor- phine, fentanyl, or hydromorphone. The available studies also suggest that IV or epidural techniques do not influence cognitive function differently. However, future investigations of sufficient study size and more standardized methods of defining outcomes are neces- sary to confirm the current findings.

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