Intrathecal Dexmedetomidine and Postoperative Delirium in Elderly Hip Fracture Surgery

Postoperative delirium (POD) is a common and serious complication in elderly patients undergoing surgical repair for hip fractures, often triggered by acute pain, surgical stress, neuroinflammation, and opioid consumption. Although spinal anesthesia using bupivacaine is commonly performed, local anesthetics alone often require additional systemic rescue opioids for postoperative pain relief, which can further increase delirium risk. Dexmedetomidine is a selective alpha-2 adrenergic agonist that has demonstrated neuroprotective, anti-inflammatory, and opioid-sparing effects.

The purpose of this clinical trial is to evaluate whether adding intrathecal dexmedetomidine as an adjuvant to hyperbaric bupivacaine during spinal anesthesia reduces the incidence and severity of postoperative delirium compared to hyperbaric bupivacaine alone in geriatric patients undergoing hip fracture surgeries.

Participants will be randomly assigned to one of two groups:

* Dexmedetomidine Group: Receives hyperbaric bupivacaine 0.5% (10 mg) combined with 5 µg dexmedetomidine intrathecally. * Control Group: Receives hyperbaric bupivacaine 0.5% (10 mg) combined with normal saline intrathecally.

The primary outcome is the incidence of postoperative delirium evaluated using the Confusion Assessment Method (CAM) twice daily during the first 48 hours following surgery. Secondary assessments include the duration and severity of delirium episodes, spinal block characteristics, hemodynamic stability, postoperative pain scores, rescue analgesic consumption, sedation levels, adverse events, and total hospital length of stay.

Not yet recruiting

Trial opening soon.

Get Notified

Key information

Conditions

Postoperative Delirium Confusion Delirium Emergence Delirium Femoral Fractures Fractures, Bone Hip Fractures Hip Injuries Leg Injuries Mental Disorders Nervous System Diseases Neurobehavioral Manifestations Neurocognitive Disorders Neurologic Manifestations Pathologic Processes Pathological Conditions, Signs and Symptoms Postoperative Complications Signs and Symptoms Wounds and Injuries

Age range

65 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 2 / Phase 3

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Elderly patients aged 65 years or older.
American Society of Anesthesiologists (ASA) physical status I, II, or III.
Patients scheduled for elective or emergency hip fracture surgeries (e.g., internal fixation, hemiarthroplasty, or total hip arthroplasty).
Eligible for and scheduled to undergo the procedure under spinal anesthesia.
Written informed consent provided by the patient or their legally authorized representative.

Exclusion criteria

Patient or legal representative refusal to participate in the study or receive spinal anesthesia.
Absolute contraindications to spinal anesthesia (e.g., coagulopathy, bleeding disorders, localized infection at the puncture site, or severe hypovolemia).
Pre-existing cognitive or neurological impairment (diagnosed dementia, baseline Mini-Mental State Examination [MMSE] score < 24, history of recent stroke, severe psychiatric illness, or chronic use of sedatives/antidepressants).
Cardiovascular contraindications (baseline bradycardia with heart rate < 50 beats/min, advanced second- or third-degree atrioventricular block, or severe baseline hypotension with mean arterial pressure < 65 mmHg).
Severe end-stage organ failure (severe hepatic or renal impairment).
Severe auditory or visual impairment hindering proper cognitive evaluation, or inability to communicate.
Intraoperative failure of spinal anesthesia requiring conversion to general anesthesia, surgical duration exceeding 2 hours, or massive intraoperative blood loss/hemodynamic instability.

Treatment and study plan

Dexmedetomidine

Drug

A single intrathecal dose of 5 µg dexmedetomidine (diluted in normal saline to 0.5 mL) combined with hyperbaric bupivacaine 0.5% (10 mg, 2.0 mL), administered via lumbar puncture prior to surgery.

Hyperbaric Bupivacaine with Normal Saline

Drug

A single intrathecal injection of hyperbaric bupivacaine 0.5% (10 mg, 2.0 mL) combined with 0.5 mL of 0.9% normal saline (placebo volume equivalent), administered via lumbar puncture prior to surgery.

Primary outcomes

Incidence of Postoperative Delirium Assessed by the Confusion Assessment Method (CAM)

Time frame: 48 hours

Incidence is defined as the presence of postoperative delirium, assessed using the Confusion Assessment Method (CAM). A participant is considered positive for delirium if they exhibit Feature 1 (acute onset and fluctuating course) and Feature 2 (inattention), plus either Feature 3 (disorganized thinking) or Feature 4 (altered level of consciousness). Assessments are conducted twice daily.

Sponsors and collaborators

Lead sponsor

Assiut University

Other

Registry information

Official study title

Effect of Intrathecal Dexmedetomidine as an Adjuvant to Hyperbaric Bupivacaine on the Incidence of Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgeries Under Spinal Anesthesia

Important dates

Study start: 2026
Primary completion: 2027
Study completion: 2027
First posted: Sep 9, 2026
Registry last updated: Sep 9, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Published trials that share one or more normalized conditions with this study.

Completed