Clinical Trial ARTICLE
Protective effect of celecoxib on early postoperative cognitive dysfunction in geriatric patients
- 1Department of Anesthesiology, Xuzhou Central Hospital, China
- 2Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, China
- 3Department of Anesthesiology, Suzhou Xiangcheng People’s Hospital, China
- 4Department of Anesthesiology, Xuzhou Cancer Hospital, China
- 5Department of neurology, Xuzhou Cancer Hospital, China
- 6Department of Pain, Shandong Provincial Hospital, China
Objective: Inflammation plays a key role in the etiology and pathology of postoperative cognitive dysfunction (POCD). Cyclooxygenase (COX)-2 inhibitor celecoxib is used for the treatment of acute pain due to its potent anti-inflammatory and analgesic effects. Herein, we evaluated the effects of celecoxib on POCD in geriatric patients.
Methods: A total of 178 geriatric patients undergoing total knee arthroplasty were randomly divided into two groups and treated with celecoxib (group C) or placebo (group P). The levels of perioperative plasma COX-2, IL-1β, IL-6, TNF-α, neuron-specific enolase and S100β were detected in all patients. The pain intensity was measured by numerical rating scale (NRS). A battery of 9 neuropsychological tests was performed pre-operatively and 1 week, and 3 months postoperatively. Patients, whose postoperative performance declined by≧1 standard deviation as compared to each preoperative test score on ≧2 tests, were classified as POCD.
Results: A significant decrease in POCD incidence was found in group C as compared to group P on postoperative day 7 (12.3% vs. 34.1%; p<0.05). POCD incidence did not differ between the two groups at the 3-month follow-up (8.8% vs. 9.7%). NRS scores at days 3 and 4 post-surgery were significantly lower in group C (p<0.05). Patients in group C showed lower level of plasma COX-2, IL-1β, IL-6, TNF-α and S100β as compared to group P postoperatively (p<0.05).
Conclusion: These results demonstrated that celecoxib can decrease early POCD incidence after total knee arthroplasty in geriatric patients, which might be mediated by suppressing inflammation and acute postoperative pain caused by surgical trauma.
Keywords: Celecoxib, postoperative cognitive dysfunction, Postoperative pain, Geriatric patients, cyclooxygenase-2 inhibitor
Received: 16 Mar 2018;
Accepted: 13 Jul 2018.
Edited by:Cristiano Chiamulera, Università degli Studi di Verona, Italy
Reviewed by:Domenico De Berardis, Azienda Usl Teramo, Italy
Abel Santamaria, Instituto Nacional de Neurología y Neurocirugía (INNN), Mexico
Copyright: © 2018 Zhu, Yao, Li, Wu, Lei, Zhou, Yan, Deng, Zhang, Ping, Wu, Wang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
MD, PhD. Yuqing Wu, Xuzhou Medical University, Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, China, email@example.com
MD. Shengtao Wang, Shandong Provincial Hospital, Department of Pain, Jinan, China, firstname.lastname@example.org
Dr. Liwei Wang, Xuzhou Central Hospital, Department of Anesthesiology, Xuzhou, China, email@example.com