Pain assessment in critical patients using the Behavioral Pain Scale

Oliveira, Laudice Santos; Macedo, Maiara Pimentel; Silva, Stefany Ariadley Martins da; Oliveira, Ana Paula de Freitas; Santos, Victor Santana

doi:10.5935/2595-0118.20190021

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ORIGINAL ARTICLE • BrJP 2 (2) • Apr-Jun 2019 • https://doi.org/10.5935/2595-0118.20190021 copy

Pain assessment in critical patients using the Behavioral Pain Scale

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

The sensation of pain is essential for life, and its assessment in critical non-contacting patients can be performed using validated scales. The Behavioral Pain Scale is a highly accurate tool that has been widely used in this group of patients. This study aimed to describe and characterize pain and the use of analgesia in the emergency or intensive care service.

METHODS:

This was a cross-sectional study with a quantitative approach with 67 critically ill patients unable to verbalize their pain perception, who were hospitalized in the emergency service or Intensive Care Units of a public hospital in Vitória da Conquista, Bahia from April to July 2017. Clinical and epidemiological data were collected using the medical record and then applied to the Behavioral Pain Scale for pain assessment.

RESULTS:

There was a predominance of male patients (47/70.1%). Three groups were identified based on the use of sedatives and analgesics: patients taking sedatives and analgesics combined, only analgesia, and those without any sedation or analgesia. We observed ascending Behavioral Pain Scale scores in all groups during tracheal suction, but the same did not occur with the physiological parameters.

CONCLUSION:

The study proposes the adoption of pain assessment scales in critical patients, such as the Behavioral Pain Scale, as well as the use of protocols for analgesia management, and consequently improve the quality of care and patient's recovery.

Keywords:
Emergency medical services; Intensive Care Units; Pain; Pain management; Pain measurement

Items	Description	Score
Facial expression	Relaxed Partially contracted (e.g., lowering eyelid) Completely contracted (eyes closed) Facial contortion	1 2 3 4
Movement of the upper limbs	No motion Partial motion Full motion with finger flexion Permanently contracted	1 2 3 4
Comfort with the mechanical ventilation	Tolerant Cough, but tolerant of mechanical ventilation most of the time Fighting with the fan No ventilation control	1 2 3 4

Categorical variables	n (%)
Gender, male	47 (70.1)
Area, urban	51 (76.1)
Diagnostic classification
Clinical	49 (73.1)
Trauma	18 (26.9)
Comorbidity
Yes	41 (61.2)
Pharmacological scheme
Prescribed sedation and analgesia
Group 1	31 (46.3)
Group 2	18 (26.9)
Group 3	16 (23.9)
Pain assessment
BPS ≥5^* * 201 observations,	70 (34.8)
BPS ≥5 (During TS) ^ 67 observations	61 (91)
Numerical variables	Mean (SD)
Age, median (IQI) FOUR	56 (36-74) 6.2±3.63
Coma Glasgow scale	4.3±2.16
RASS	-4.5±1.29

Groups	Parameters	Mean±SD			p-value^* * ANOVA test.
Groups	Parameters	At rest	Eye cleansing	Tracheal suction	p-value^* * ANOVA test.
Group 1	HR (bpm)	88.7 (26.6)	89.9 (26.4)	104 (29.1)	<0.001
	RR (irpm)	15.7 (3.8)	15.6 (3.9)	20.4 (7.4)	<0.001
	SpO₂ in%	97.3 (4.0)	97.3 (3.8)	95.0 (4.9)	<0.001
	SBP (mmHg)	122.3 (29.4)	122.3 (28.9)	139.8 (38.5)	<0.001
	DBP (mmHg)	67.3 (15.4)	67.7 (14.8)	80.1 (18.7)	<0.001
	MAP (mmHg)	83.2 (20.8)	86.4 (16.9)	101.3 (24.2)	<0.001
	Temperature ºC	35.9 (1.2)	35.9 (1.2)	35.9 (1.2)	0.846
Group 2	HR (bpm)	90.9 (21.7)	91.2 (22.3)	104.4 (20.1)	<0.001
	RR (irpm)	16.1 (4.5)	16.4 (4.7)	25.2 (9.2)	<0.001
	SpO₂ in%	97.7 (2.5)	97.8 (2.6)	95.3 (3.6)	<0.001
	SBP (mmHg)	121.2 (27.8)	123.8 (25.5)	141.8 (30.8)	<0.001
	DBP (mmHg)	63.6 (12.5)	64.8 (11.6)	77.9 (11.8)	<0.001
	MAP (mmHg)	82.5 (17.2)	84.6 (15.4)	101.7 (17.9)	<0.001
	Temperature ºC	35.7 (1.1)	35.7 (1.1)	35.7 (1.1)	0.717
Group 3	HR (bpm)	87.2 (26.5)	91.6 (16.0)	100.8 (15.4)	<0.001
	RR (irpm)	17.8 (6.0)	17.8 (6.2)	23.0 (7.9)	<0.001
	SpO₂ in%	96.6 (3.2)	96.7 (3.1)	94.7 (5.4)	0.025
	SBP (mmHg)	121.8 (29.4)	121.9 (29.3)	150.3 (43.5)	0,001
DBP (mmHg)		67.8 (16.3)	68.4 (16.7)	83.1 (21.8)	<0.001
	MAP (mmHg)	84.8 (20.0)	85.1 (19.8)	103.7 (25.7)	<0.001
	Temperature ºC	35.6 (1.4)	35.6 (1.5)	35.5 (1.5)	0.368

Groups	BPS Scores	Mean±SD			p-value^* * ANOVA test.
Groups	BPS Scores	At rest	Eye cleansing	Tracheal suction	p-value^* * ANOVA test.
Group 1	Facial expression	1.1 (0.3)	1.1 (0.4)	2.1 (0.9)	<0.001
	Upper limbs	1.0 (0.2)	1.0 (0.2)	2.1 (0.7)	<0.001
	Adaptation to mechanical ventilation	1.0 (0.1)	1.0 (0.1)	2.0 (0.3)	<0.001
	Total	3.1 (0.3)	3.2 (0.4)	6.2 (1.4)	<0.001
Group 2	Facial expression	1.3 (0.6)	1.4 (0.6)	3.2 (1.0)	<0.001
	Upper limbs	1.1 (0.3)	1.1 (0.3)	2.8 (1.0)	<0.001
	Adaptation to mechanical ventilation	1.1 (0.2)	1.1 (0.2)	2.2 (0.6)	<0.001
	Total	3.4 (1.0)	3.6 (1.0)	8.2 (2.4)	<0.001
Group 3	Facial expression	1.3 (0.7)	1.4 (0.7)	2.7 (0.9)	<0.001
	Upper limbs	1.3 (0.6)	1.3 (0.6)	2.7 (1.0)	<0.001
	Adaptation to mechanical ventilation	1.1 (0.2)	1.1 (0.2)	1.9 (0.4)	<0.001
	Total	3.7 (1.4)	3.7 (1.4)	7.3 (2.1)	<0.001

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[1] Correspondence to: Rua Hormindo Barros, 58, Quadra 17, Lote 58 - Bairro Candeias, 45.029-094 Vitória da Conquista, BA, Brasil. E-mail: enf.lais@gmail.com