Preemptive hydromorphone analgesia reduces postoperative delirium and stress response in laparoscopic cholecystectomy patients

Abstract

Objective: To evaluate the effects of preemptive hydromorphone analgesia on postoperative delirium and stress response in patients undergoing laparoscopic cholecystectomy.

Methods: A retrospective cohort study was conducted, including 167 patients who underwent laparoscopic cholecystectomy at Xi'an Central Hospital between June 2021 and November 2023. Patients were categorized into an observation group (n=87) receiving preemptive hydromorphone hydrochloride analgesia and a control group (n=80) without preemptive analgesia. Postoperative pain was assessed using the Visual Analogue Scale (VAS), and stress response was evaluated by measuring epinephrine, norepinephrine, and dopamine levels. The incidence of postoperative delirium was recorded. Logistic regression analysis was performed to identify risk factors for postoperative delirium.

Results: The VAS score at 30 minutes postoperative was significantly lower in the observation group than that in the control group (P<0.001). Similarly, postoperative levels of epinephrine, norepinephrine, and dopamine were significantly reduced in the observation group (all P<0.001). The incidence of postoperative delirium was also significantly lower in the observation group (P<0.05). Multivariate logistic regression analysis identified higher doses of propofol (P<0.001; odds ratio =3.102, 95% confidence interval: 1.144-9.777) and remifentanil (P=0.001; odds ratio =2.376, 95% confidence interval: 1.469-4.290) as independent risk factors for postoperative delirium, indicating a significant increase in delirium risk with higher drug doses.

Conclusion: Preemptive hydromorphone analgesia significantly alleviates postoperative pain, reduces stress responses, and lowers the incidence of postoperative delirium in patients undergoing laparoscopic cholecystectomy. Compared to conventional analgesia strategies, hydromorphone provides superior pain control and a favorable safety profile.

Keywords: Hydromorphone hydrochloride; laparoscopic cholecystectomy; postoperative delirium; preemptive analgesia; stress response.

Figure 1

Comparison of HR and MAP changes between control and observation groups at different time points. A. Comparison of HR at three time points: T1, T2, and T3. B. Comparison of MAP at three time points: T1, T2, and T3. Note: ***P<0.001 indicates a significant difference between groups; ns indicates no significant difference; HR, heart rate; MAP, mean arterial pressure.

Figure 2

Comparison of E, NE, and DA levels between control and observation groups at T1 and T3. A. Comparison of E at two time points: T1 and T3. B. Comparison of NE at two time points: T1 and T3. C. Comparison of DA at two time points: T1 and T3. Note: ****P<0.001 indicates a significant difference between groups; ns indicates no significant difference; E, epinephrine; NE, norepinephrine; DA, dopamine.

Figure 3

Comparison of surgical time, propofol dosage, and remifentanil dosage between control and observation groups. A. Comparison of surgical time. B. Comparison of propofol dosage. C. Comparison of remifentanil dosage. Note: ****P<0.001 indicates a significant difference between groups; ns indicates no significant difference.

Figure 4

Comparison of extubation time and spontaneous breathing recovery time between control and observation groups. A. Comparison of spontaneous breathing recovery time. B. Comparison of extubation time. Note: ns indicates no significant difference.

Figure 5

Comparison of VAS and RAMSAY scores between control and observation groups at T3, T4, and T5. A. Comparison of VAS at three time points: T3, T4, and T5. B. Comparison of RAMSAY at three time points: T3, T4, and T5. Note: ***P<0.001 indicates a significant difference between groups; ns indicates no significant difference; VAS, Visual Analogue Scale; RAMSAY, Ramsay Sedation Scale.