Effect of electroacupuncture combined with dexmedetomidine on postoperative cognitive dysfunction in hip and knee arthroplasty patients.

IMPORTANCE: Postoperative cognitive dysfunction (POCD) is a common complication in elderly patients, yet effective preventive strategies remain limited. The combined efficacy of electroacupuncture (EA) and dexmedetomidine in this context is unclear. OBJECTIVE: To investigate the effects of electroacupuncture combined with dexmedetomidine on the incidence of POCD and postoperative inflammatory factors in elderly patients undergoing hip or knee arthroplasty. METHODS: In this single-center, prospective, randomized controlled trial, 120 elderly patients were randomly assigned to three groups: the electroacupuncture (EA) group, the dexmedetomidine (D) group, and the combination (ED) group. All participants underwent elective hip or knee arthroplasty. Primary outcomes and measurements: The primary outcome was the incidence of POCD assessed by the Mini-Mental State Examination (MMSE) at 1 month postoperatively. Secondary outcomes included serum levels of S-100β, TNF-α, and IL-6, as well as postoperative Visual Analog Scale (VAS) pain scores. RESULTS: Of the 120 randomized participants (mean [SD] age, 72.9 ± 5.9 years), 113 completed the study. The incidence of POCD was significantly lower in the EA+Dex group (10%) compared with the EA group (30%) and the Dex group (32.5%) (P < 0.05). Additionally, postoperative serum levels of S-100β, TNF-α, and IL-6 were significantly reduced in the combination group compared with the monotherapy groups (P < 0.05). CONCLUSION: The findings suggest that the combined application of electroacupuncture and dexmedetomidine may be associated with a lower incidence of POCD at 1 month after hip or knee arthroplasty in elderly patients. The observed reduction in serum biomarkers indicates a potential role in modulating neuroinflammation, though further multicenter studies are warranted to validate these findings and elucidate the precise mechanisms.