Page 19 - GALENIKA MEDICAL JOURNAL

POCD starijih bolesnika sa frakturom kuka kod kojih postoji se povećava kod starijih bolesnika, posebno muškog pola
50-70% učestalosti teškog bola tokom prvih 24 sata od po- i sa prisutnim komorbiditetima 8, 21 . Oko 15-30% bolesnika
vrede, kao i to da je bol ne samo predisponirajući, već i pre- umire tokom godinu dana od operacije. Rana operacija,
cipitirajući faktor za nastanak ovih poremećaja 11, 22 . rana mobilizacija, primjena antibiotika i tromboprofilakse
smanjuju smrt od bronhopneumonije i plućne embolije .
23
Mortalitet bolesnika nakon operacije karlične kosti u
ovom istraživanju iznosio je 3,3%. Prema podacima iz litera-
ture, mortalitet je dosta visok i nepromijenjen posljednjih 20
godina: 30 - dnevni mortalitet iznosi 8,4%, a ovaj procenat

Zaključak

Jedna intratekalna injekcija deksametazona u spinalnoj anesteziji za hiruršku korekciju frakture kuka
snižava perioperativni stresni odgovor smanjenjem plazmatske koncentracije kortizola sa dužim
analgetskim efektom, manjom učestalošću postoperativnog delirijuma i postoperativnih kognitivnih
poremećaja, kao i boljim mogućnostima rehabilitacije i istovremeno skraćuje dužinu hospitalizacije,

što opravdava ovaj anesteziološki obrazac kao preporučen metod izbora.

Abstract
Introduction: Hip fracture is the most common cause of emergency hospital admissions among the elderly population
and is associated with high postoperative morbidity. The hypothesis is that a single intrathecal dose of Dexamethasone
with Levobupivacaine for surgical correction of hip fracture reduces surgical stress and contributes to better treatment
outcomes.

Method: Elderly patients with hip fracture who underwent surgery under spinal anesthesia with Levobupivacaine were
analyzed, with one group receiving a single intrathecal dose of Dexamethasone and the other group serving as a control
(group DLSA/control group LSA). The following variables were monitored: gender, type of injury, cortisol levels, time elapsed
from injury to surgical intervention, pain intensity, occurrence of delirium, postoperative cognitive deficits and other
complications, length of hospital stay, and mortality.

Results: Reduced cortisol concentrations, prolonged analgesia duration, and shorter hospitalization duration were
observed in DLSA group, compared to the LSA group.

Conclusion: A single intrathecal injection of Dexamethasone in spinal anesthesia for surgical correction of hip fracture
reduces perioperative stress response by lowering plasma cortisol concentration, providing a longer analgesic effect,
reducing the incidence of delirium and POCD (Postoperative Cognitive Dysfunction), and improving rehabilitation
prospects. This leads to a shorter hospitalization duration, justifying this anesthetic approach as a recommended method
of choice.

Keywords: hip fracture, stress, pain, cortisol, spinal anesthesia, intrathecal Dexamethasone

Literatura 2. Bagi B, Kalezić N. Procjena rizika za postoperativni delirijum i
postoperativne kognitivne poremećaje, prevencija i lečenje. u: Kalezić
N. Perioperativna medicina 1. Medicinski fakultet Univerziteta u
1. Kalezić N, Jovanović V, Dimić N, Sekulić A, Srećković S, Pavlović A. Beogradu, 2020; 22:495-512.
Specifičnosti procene operativnog rizika i perioperativnog lečenja 3. Šakić L, Šakić K, Šakić Š. Regional Anaesthesia for Hip Surgeries // Hip
gerijatrijskih pacijenata, u: Kalezić N. Perioperativna medicina 1. Replacement / Suarez-Ahedo, Carlos (ur.).London : Delhi: Open Access
Medicinski fakultet Univerziteta u Beogradu, 2020; 7:133-45.
books ; IntechOpen, 2022. str. 1-14

ORIGINALNI RADOVI Galenika Medical Journal, 2023; 2(7):13-18. 17