Document Detail

Postoperative delirium: the importance of pain and pain management.
MedLine Citation:
PMID:  16551935     Owner:  NLM     Status:  MEDLINE    
Postoperative delirium is common in geriatric patients. Few studies have examined events in the postoperative period that may contribute to the occurrence of postoperative delirium. We hypothesized that postoperative delirium is related to postoperative pain and/or pain management strategy. Patients aged > or =65 years who were scheduled for major noncardiac surgery were studied. A structured interview was conducted preoperatively and for the first 3 postoperative days to determine the presence of delirium using the Confusion Assessment Method. The method of postoperative pain management, as well as pre- and postoperative medications for the first 3 days, was collected. Pre- and postoperative pain at rest and with movement was recorded using the Visual Analog Scale. Three hundred thirty-three patients, with a mean age of 74 +/- 6 years, were studied. After surgery, 46% of patients developed postoperative delirium. By multivariate logistic regression, age (odds ratio [OR], 2.5; 95% confidence interval [CI] 1.5 to 4.2), moderate (OR, 2.2; 95% CI 1.2 to 4.0) and severe (OR, 3.7; 95% CI 1.5 to 9.0) preoperative resting pain, and increase in level of pain from baseline to postoperative day one (OR, 1.1; 95% CI 1.01 to 1.2) were independently associated with a greater risk for the development of postoperative delirium. In contrast, patients who used oral opioid analgesics as their sole means of postoperative pain control were at decreased risk of developing delirium in comparison with those who used opioid analgesics via IV patient-controlled analgesia technique (OR, 0.4; 95% CI 0.2 to 0.7). These results validate our hypothesis that pain and pain management strategies are important factors related to the development of postoperative delirium in elderly patients.
Linnea E Vaurio; Laura P Sands; Yun Wang; E Ann Mullen; Jacqueline M Leung
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  102     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-03-22     Completed Date:  2006-04-13     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1267-73     Citation Subset:  AIM; IM    
Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143-0648, USA.
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MeSH Terms
Aged, 80 and over
Analgesics / adverse effects,  therapeutic use
Chi-Square Distribution
Confidence Intervals
Delirium / epidemiology,  psychology*
Disease Management
Logistic Models
Odds Ratio
Pain / drug therapy,  epidemiology,  psychology*
Pain Measurement / drug effects,  standards
Pain, Postoperative / epidemiology,  psychology*,  therapy*
Postoperative Complications / chemically induced,  epidemiology,  psychology
Grant Support
1K24-AG00948-05/AG/NIA NIH HHS
Reg. No./Substance:

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