Preoperative electroacupuncture for prevention of postoperative delirium in older adults undergoing total knee arthroplasty: protocol for a multicenter randomized controlled trial

Abstract

Introduction: Postoperative delirium is a common and serious complication following total knee arthroplasty in older adults, leading to increased mortality, prolonged hospitalization, and cognitive decline. Although electroacupuncture has shown promise in improving cognitive function, its efficacy in preventing postoperative delirium following arthroplasty remains unknown. This study investigates whether preoperative electroacupuncture prevents postoperative delirium in older adults undergoing total knee arthroplasty. Methods and analysis: This multicenter, randomized, double-blind, sham-controlled trial will enroll 1460 participants aged 65–90 years scheduled for elective total knee arthroplasty. Participants will be randomly assigned (1:1) to receive either active electroacupuncture (at GV24 and bilateral GB13 acupoints, 1 mA for 30 min before anesthesia induction; n = 730) or sham electroacupuncture (n = 730). The primary outcome is delirium incidence within 72 h after surgery, assessed using the Confusion Assessment Method. Secondary outcomes include delirium severity and subtypes, cognitive function, anxiety, depression, sleep quality, pain scores, cumulative morphine consumption, recovery quality, length of hospital stay, and adverse events. Ethics and dissemination: The protocol was approved by the Institutional Review Board of Fujian Provincial Hospital (K2023-02-004/02). All participating centers obtained ethics committee approval before enrollment. Written informed consent will be obtained from all participants. Results will be published in peer-reviewed journals, regardless of the outcome.