The effect of oxycodone vs. sufentanil on postoperative delirium in elderly patients undergoing major abdominal surgery: a randomized trial

Background: Postoperative delirium (POD) is a neurological disorder that frequently affects elderly patients undergoing major abdominal surgery. Existing research indicates that perioperative administration of oxycodone may enhance postoperative cognitive function. This study was conducted to examine the impact of preemptive analgesia with oxycodone on the occurrence of POD in elderly patients undergoing major abdominal surgery. Methods: We randomly assigned 120 patients to receive oxycodone versus sufentanil. Both oxycodone and sufentanil were administered ten minutes before the induction of anesthesia. The primary outcome was the incidence of POD within 7 days post-surgery (or before discharge). Delirium was assessed twice daily using either a Diagnostic Interview for the Confusion Assessment Method or the Confusion Assessment Method for the Intensive Care Unit. Secondary outcomes included postoperative opioid consumption, pain score, patient satisfaction score, and adverse events. Results: The final analysis included 112 patients and the incidence of POD was similar between oxycodone and sufentanil(risk ratio, 0.64; 95% confidence interval, 0.28 to 1.45; p = 0.282). However, patients treated with oxycodone had lower postoperative opioid consumption, reduced pain scores and postoperative nausea and vomiting. Conclusions: Although oxycodone preemptive analgesiadid not reduce the incidence of POD, it demonstrated effective analgesic properties and reduced postoperative adverse events. Clinical Trial Registration: The study was registered with the Chinese Clinical Trial Registration Center (ChiCTR2200064308, 02 October 2022).