Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20230080-en
Brazilian Journal of Pain
Original Article

Delirium and pain in patients in the immediate postoperative period of cardiac surgery: prevalence and associated risk factors

Delirium e dor em pacientes no pós-operatório imediato de cirurgia cardíaca: prevalência e fatores de risco associados

Luiz Fernando Sposito Ribeiro Baltazar; Gabriel Baeta Branquinho Reis; Arthur Marot de Paiva; Pedro Guimarães Moreira da Silva; Artur Henrique de Souza; Giulliano Gardenghi

Downloads: 0
Views: 287

Abstract

BACKGROUND AND OBJECTIVES: Delirium is an acute mental status change, with fluctuating course and high incidence in cardiac surgery (CS) post-operative (PO) period. Delirium can lead to short and long-term consequences. The aim of this study was to assess the prevalence of delirium and pain and their risk factors on the 1st PO day after CS.
METHODS: This was a cross-sectional analytical research. To determine the presence of PO delirium, the Confusion Assessment Method modified for Intensive Care Unit setting (CAM-ICU) and the Richmond Agitation Sedation Scale (RASS) were used. PO pain was analyzed using the Visual Analogue Pain Scale (VAS) and the presence of neuropathic components was analyzed using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale. After bedside analysis, patients were divided into Delirium (D) and Without Delirium (WD) groups.
RESULTS: The total number of patients was 79. The prevalence of delirium was 16.5% (95% CI = 9.06 - 26.49%) and the mean number of comorbidities in the preoperative period was a significant risk factor for the occurrence of delirium (D =4.15±2.37 versus WD=2.96±1.78, p: 0.04). Another significant risk factor was the group older than 65 years of age, with the occurrence of delirium 1.45 times higher (PR=1.12-1.88, p: 0.0014). Regarding pain evaluation, 72.15% (95% CI 60.93 - 81.65%) reported it in the 1st PO day.
CONCLUSION: The prevalence of delirium was similar to previous studies. The number of previous comorbidities and advanced age were risk factors for delirium. Pain was present predominantly over the sternotomy incision region.

Keywords

Delirium, Cardiovascular surgical procedures, Postoperative pain

Resumo

JUSTIFICATIVA E OBJETIVOS: Delirium é uma alteração aguda do estado mental, com curso flutuante e alta incidência no pós-operatório (PO) de cirurgia cardíaca (CC). O delirium pode levar a consequências a curto e longo prazo. O objetivo deste estudo foi avaliar a prevalência de delirium e dor e seus fatores de risco no 1º dia PO após CC. 
MÉTODOS: Trata-se de um estudo transversal analítico. Para determinar delirium no PO, foram utilizados o Confusion Assessment Method modificado para ambiente de Unidade de Terapia Intensiva (CAM-UTI) e a Richmond Agitation Sedation Scale (RASS). A dor PO foi analisada por meio da Escala Analógica Visual (EAV) e a presença de componentes neuropáticos foi analisada por meio da Escala de Avaliação de Sintomas e Sinais Neuropáticos de Leeds (LANSS). Após análise, os pacientes foram divididos nos grupos Delirium (D) e Sem Delirium (SD). 
RESULTADOS: Foram estudados 79 pacientes. A prevalência de delirium foi de 16,5% (IC 95%=9,06-26,49%) e o número médio de comorbidades no pré-operatório foi um fator de risco significativo para a ocorrência de delirium (D=4,15±2,37 versus SD=2,96±1,78, p: 0,04). Outro fator de risco foi o grupo com mais de 65 anos, com ocorrência de delirium 1,45 vezes maior (RP=1,12-1,88, p: 0,0014). Em relação à avaliação da dor, 72,15% (IC 95% 60,93-81,65%) a relataram no 1º dia PO. 
CONCLUSÃO: A prevalência de delirium foi semelhante à de estudos anteriores. O número de comorbidades prévias e a idade avançada foram fatores de risco para delirium. A dor estava presente predominantemente na região da incisão da esternotomia.

Palavras-chave

Delirium, Dor pós-operatória, Procedimentos cirúrgicos cardiovasculares

References

1 Saczynski JS, Marcantonio ER, Quach L, Fong TG, Gross A, Inouye SK, Jones RN. Cognitive trajectories after postoperative delirium. N Engl J Med. 2012;367(1):30-9.

2 Marcantonio ER. Delirium in hospitalized older adults. N Engl J Med. 2017;377(15):1456-66.

3 McPherson JA, Wagner CE, Boehm LM, Hall JD, Johnson DC, Miller LR, Burns KM, Thompson JL, Shintani AK, Ely EW, Pandharipande P P. Delirium in the cardiovascular ICU: exploring modifiable risk factors. Crit Care Med. 2013;41(2):405-13. Erratum in: Crit Care Med. 2013;41(4):e41.

4 Sasseron AB, Figueiredo LC, Trova K, Cardoso AL, Lima NM, Olmos SC, Petrucci O. Does the pain disturb the respiratory function after open heart surgery? Rev Bras Cir Cardiovasc. 2009;24(4):490-6.

5 Andrade EV, Barbosa MH, Barichello E. Avaliação da dor em pós-operatório de cirurgia cardíaca. Acta Paul Enferm. 2010;23(2).

6 Giacomazzi CM, Lagni VB, Monteiro MB. A dor pós-operatória como contribuinte do prejuízo na função pulmonar em pacientes submetidos à cirurgia cardíaca. Braz J Cardiovasc Surg. 2006;21(4).

7 Brown CH. Delirium in the cardiac surgical ICU. Curr Opin Anaesthesiol. 2014;27(2):117-22.

8 Kirfel A, Menzenbach J, Guttenthaler V, Feggeler J, Mayr A, Coburn M, Wittmann M. Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital. Aging Clin Exp Res. 2021;33(11):3047-56.

9 Chen H, Mo L, Hu H, Ou Y, Luo J. Risk factors of postoperative delirium after cardiac surgery: a meta-analysis. J Cardiothorac Surg. 2021;16(1):113.

10 Sockalingam S, Parekh N, Bogoch II, Sun J, Mahtani R, Beach C, Bollegalla N, Turzanski S, Seto E, Kim J, Dulay P, Scarrow S, Bhalerao S. Delirium in the postoperative cardiac patient: a review. J Card Surg. 2005;20(6):560-7.

11 Gottesman RF, Grega MA, Bailey MM, Pham LD, Zeger SL, Baumgartner WA, Selnes OA, McKhann GM. Delirium after coronary artery bypass graft surgery and late mortality. Ann Neurol. 2010;67(3):338-44.

12 Matioli KBB, Moraes Filho IM, Sousa TV, Pereira MC, Silva RM, Sá ES, et al. Delirium: prevalência e fatores associados ao pós-operatório de cirurgia cardiovascular em idosos. Rev Baiana Enferm. 2021;35:e42203.

13 Rudolph JL, Jones RN, Levkoff SE, Rockett C, Inouye SK, Sellke FW, Khuri S F, Lipsitz LA, Ramlawi B, Levitsky S, Marcantonio ER. Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation. 2009;119(2):229-36.

14 Smulter N, Lingehall HC, Gustafson Y, Olofsson B, Engström KG. Delirium after cardiac surgery: incidence and risk factors. Interact Cardiovasc Thorac Surg. 2013;17(5):790-6.

15 Swart LM, van der Zanden V, Spies PE, de Rooij SE, van Munster BC. The comparative risk of delirium with different opioids: a systematic review. Drugs Aging. 2017;34(6):437-43.

16 Staveski SL, Pickler RH, Khoury PR, Ollberding NJ, Donnellan AL, Mauney JA, Lincoln PA, Baird JD, Gilliland FL, Merritt AD, Presnell LB, Lanese AR, Lisanti AJ, Large BJ, Fineman LD, Gibson KH, Mohler LA, Callow L, Barnes SS, Whalen RL, Grant MJC, Sheppard C, Kline-Tilford AM, Steadman PW, Shafland HC, Corlett KM, Kelly S P, Ortman LA, Peyton CE, Hagstrom SK, Shields AM, Nye T, Alvarez TCE, Justice LB, Kidwell S T, Redington AN, Curley MAQ. Prevalence of ICU delirium in postoperative pediatric cardiac surgery patients. Pediatr Crit Care Med. 2021;22(1):68-78.

17 Sanson G, Khlopenyuk Y, Milocco S, Sartori M, Dreas L, Fabiani A. Delirium after cardiac surgery. Incidence, phenotypes, predisposing and precipitating risk factors, and effects. Heart Lung. 2018;47(4):408-17.

18 Cruz JN da, Tomasi CD, Alves SC, Macedo RC de, Giombelli V, Cruz JGP da, et al. Incidência de delirium durante a internação em unidade de terapia intensiva em pacientes pré-tratados com estatinas no pós-operatório de cirurgia cardíaca. Rev Bras Ter Intensiva. 2012;24(1).

19 Lahtinen P, Kokki H, Hynynen M. Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity. Anesthesiology. 2006;105(4):794-800.

20 Mueller XM, Tinguely F, Tevaearai H T, Revelly J P, Chioléro R, von Segesser LK. Pain location, distribution, and intensity after cardiac surgery. Chest. 2000;118(2):391-6.

21 Engelman D T, Ben Ali W, Williams JB, Perrault L P, Reddy VS, Arora RC, Roselli EE, Khoynezhad A, Gerdisch M, Levy JH, Lobdell K, Fletcher N, Kirsch M, Nelson G, Engelman RM, Gregory AJ, Boyle EM. Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations. JAMA Surg. 2019;154(8):755-66.

22 Rafiq S, Steinbrüchel DA, Wanscher MJ, Andersen LW, Navne A, Lilleoer NB, Olsen PS. Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trial. J Cardiothorac Surg. 2014;9:52.

23 Bignami E, Castella A, Pota V, Saglietti F, Scognamiglio A, Trumello C, Pace MC, Allegri M. Perioperative pain management in cardiac surgery: a systematic review. Minerva Anestesiol. 2018;84(4):488-503.

24 Nagappa M, Weingarten TN, Montandon G, Sprung J, Chung F. Opioids, respiratory depression, and sleep-disordered breathing. Best Pract Res Clin Anaesthesiol. 2017;31(4):469-85.

25 Anwar S, Cooper J, Rahman J, Sharma C, Langford R. Prolonged Perioperative Use of pregabalin and ketamine to prevent persistent pain after cardiac surgery. Anesthesiology. 2019;131(1):119-31.

26 Khaled M, Sabac D, Marcucci M. Postoperative pain and pain management and neurocognitive outcomes after non-cardiac surgery: a protocol for a series of systematic reviews. Syst Rev. 2023; 11:280.
 


Submitted date:
07/23/2023

Accepted date:
09/27/2023

65a6e3bfa953957a3b06fcb2 brjp Articles

BrJP

Share this page
Page Sections