Postoperative pain and analgesia in patients submitted to unruptured brain aneurysm clamping

Menezes, Míriam Geisa Virgens; Ribeiro, Caíque Jordan Nunes; Nascimento, Flávio dos Santos; Alves, José Antonio Barreto; Lima, Alanna Gleice Carvalho Fontes; Ribeiro, Maria do Carmo de Oliveira

doi:10.5935/1806-0013.20170007

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ORIGINAL ARTICLES • Rev. dor 18 (1) • Jan-Mar 2017 • https://doi.org/10.5935/1806-0013.20170007 copy

Postoperative pain and analgesia in patients submitted to unruptured brain aneurysm clamping

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

Adequate postoperative pain evaluation and management are priorities for quality assistance, especially after neurological surgeries. This study aimed at evaluating postoperative pain of neurosurgical patients submitted to unruptured brain aneurysm clamping.

METHODS:

Prospective and descriptive study carried out in a charity hospital of the city of Aracaju, Sergipe, Brazil. Sample was made up of 28 patients submitted to elective craniotomy for unruptured brain aneurysm clamping. Mann-Whitney, Kruskal-Wallis and Dunn-Bonferroni tests were used for inferential analysis. Significance level was 5% throughout the study.

RESULTS:

Most patients (78.6%) were females, 64.0% had postoperative pain. There has been significant difference in the number of days with postoperative pain among patients with associated comorbidities (p=0.04) and previous surgery (p=0.01). Most patients had moderate and throbbing headache. There were no adequate pain records and most frequent analgesics were simple analgesics. Opioids prescription was incipient.

CONCLUSION:

Systematic pain evaluation should be part of multiprofessional assistance, in compliance with international and national pain institutions recommendations.

Keywords:
Analgesia; Aneurysm; Nursing; Pain; Pain measurement

Variables	n	%		Pain
			Number days	p value	% days	p value
			Mean (SD)		Mean (SD)
Gender
Male	6	21.4	2.5 (1.8)	0.81^* * Mann-Whitney test,	36 (26)	0.57^* * Mann-Whitney test,
Female	22	78.6	2.7 (1.6)		44 (23)
Age
<45	9	32.1	2.8 (2.0)	0.81^* * Mann-Whitney test,	42 (28)	0.85^* * Mann-Whitney test,
>=45	19	67.9	2.6 (1.5)		43 (22)
Pathologic background
Diabetes and hypertension	3	10.7	4.7 (0.6)^¶ ¶,¶¶ Subgroups different from 5% for Dunn-Bonferroni test.	0.04^ Kruskal-Wallis Test and	71 (13)^¶ ¶,¶¶ Subgroups different from 5% for Dunn-Bonferroni test.	0.04^ Kruskal-Wallis Test and
Hypertension	6	21.4	1.8 (1.2)^¶¶ ¶,¶¶ Subgroups different from 5% for Dunn-Bonferroni test.		30 (16)^¶¶ ¶,¶¶ Subgroups different from 5% for Dunn-Bonferroni test.
No background	19	67.9	2.6 (1.7)^¶ ¶,¶¶ Subgroups different from 5% for Dunn-Bonferroni test. .^¶¶ ¶,¶¶ Subgroups different from 5% for Dunn-Bonferroni test.		42 (24)^¶ ¶,¶¶ Subgroups different from 5% for Dunn-Bonferroni test. .^¶¶ ¶,¶¶ Subgroups different from 5% for Dunn-Bonferroni test.
Previous surgery
Yes	13	46.4	1.9 (1.8)	0.02^* * Mann-Whitney test,	31 (25)	0.01^* * Mann-Whitney test,
No	15	53.6	3.3 (1.2)		52 (17)

Variables	n (%)
Location
Frontotemporal	36 (47)
Frontal	15 (20)
Temporofrontal	8 (11)
Unilateral	8 (11)
Occipital	4 (5)
Holocranial	2 (3)
Fronto-orbital	2 (3)
Characteristics
Pulsing	51 (68)
Continuous	3 (4)
Stabbing	2 (3)
Pressing	17 (22)
Tension	2 (3)
Pain intensity
Mild	30 (40)
Moderate	41 (55)
Severe	4 (5)
Aggravating factors
Balancing head	32 (55)
Neck movements	20 (35)
Eye movement or palpation	2 (4)
Physical effort	1 (2)
None	2 (4)
Associated symptoms
Nausea	14 (19)
Vomiting	3 (4)
Sleep disturbances	5 (7)
Photophobia	2 (3)
Sweating	2 (3)
Postural vertigo	2 (3)
Tearing	1 (1)
Increased temperature	1 (1)
None	51 (59)

Variables	Pain presence and recording n (%)
	1^stPOD	2^ndPOD	3^rdPOD	4^thPOD	5^thPOD	6^thPOD	7^thPOD
Pain
Yes	18 (64)	14 (50)	15 (54)	9 (36)	10 (42)	7 (32)	2 (11)
Professional recording
Nursing team	4 (50)	5 (71)	5 (71)	4 (100)	7 (100)	1 (50)	1 (100)
Physician	4 (50)	3 (43)	3 (43)	0 (0)	0 (0)	1 (50)	1 (100)

Administered drug	Pain intensity Mean (SD)
	1^stPOD	2^ndPOD	3^rdPOD	4^thPOD	5^thPOD	6^thPOD	7^thPOD
Simple analgesics	3.7 (2.5)	2.5 (1.9)	2.2 (2.6)	1 (1.6)	2.3 (3.9)	3 (2.2)	0 (0)
NSAIDs	4.1 (2.0)	2.3 (4.0)	0.8 (1.5)	0 (0)	1.3 (2.3)	9 (0)	2 (0)
Weak opioid	1.8 (2.0)	2.5 (3.3)	1.5 (3)	0.8 (1.3)	1.3 (2.3)	0 (0)	0 (0)
Strong opioid	0 (0.0)	0 (0)	0 (0)	3 (0)	0 (0)	0 (0)	0 (0)
Simple analgesics + NSAIDs	0 (0.0)	1 (1.7)	2.4 (2.2)	2.6 (2.8)	2.9 (3.1)	1.1 (1.8)	0.3 (0.9)

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[1] Correspondence to: Av. Cláudio Batista, S/N - Bairro Sanatório 49060-108 Aracaju, SE, Brasil. E-mail: enffer2@gmail.com