Incidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study

Yao Tsung Lin,1 Kuo Mao Lan,1 Li-Kai Wang,1 Chin-Chen Chu,1 Su-Zhen Wu,1 Chia-Yu Chang,2 Jen-Yin Chen1,3 1Department of Anesthesiology, 2Department of Neurology, Chi Mei Medical Center, 3Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan...

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Autores principales:	Lin YT, Lan KM, Wang LK, Chu CC, Wu SZ, Chang CY, Chen JY
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	postoperative delirium postoperative analgesia patient controlled analgesia Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/5dc812f3add84e5fb580d9fb12ca9d3e
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spelling	oai:doaj.org-article:5dc812f3add84e5fb580d9fb12ca9d3e2021-12-02T06:54:24ZIncidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study1178-2021https://doaj.org/article/5dc812f3add84e5fb580d9fb12ca9d3e2016-12-01T00:00:00Zhttps://www.dovepress.com/incidence-risk-factors-and-phenomenological-characteristics-of-postope-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Yao Tsung Lin,1 Kuo Mao Lan,1 Li-Kai Wang,1 Chin-Chen Chu,1 Su-Zhen Wu,1 Chia-Yu Chang,2 Jen-Yin Chen1,3 1Department of Anesthesiology, 2Department of Neurology, Chi Mei Medical Center, 3Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan Background: Intravenous patient-controlled analgesia (IVPCA) is a common method of relieving pain which is a risk factor of postoperative delirium (POD). However, research concerning POD in IVPCA patients is limited. Objective: We aimed to determine the incidence, risk factors, and phenomenological characteristics of POD in patients receiving IVPCA. Methods: A prospective, cohort study was conducted in post-general anesthesia IVPCA patients aged ≥60 years. POD was measured by the Nursing Delirium Screening Scale (NuDESC; 0–10). Delirium, pain severity at rest and/or on movement, and side effects of IVPCA during 3 postoperative days were examined twice-daily by the acute pain service team. Pain severity is measured by an 11-point verbal numerical rating scale (11-point VNRS) (0–10). An 11-point VNRS >3 was considered inadequate pain relief. If POD (detected by NuDESC ≥1) is suspected, consulting a neurologist or a psychiatrist to confirm suspected POD is required. Results: In total, 1,608 patients were included. The incidence rate of POD was 2.2%. Age ≥70 years and American Society of Anesthesiologists physical status >III were the risk factors of POD in IVPCA patients. Approximately three-quarters of all POD cases occurred within the first 2 postoperative days. For pain at rest, patients with inadequate pain relief had significantly greater rates of POD than patients with adequate pain relief (day 1, 8.4% vs 1.5%, P<0.001; day 2, 9.6% vs 2.0%, P=0.028; day 3, 4.1% vs 2.1%, P=0.412). However, the incidence of POD was not associated with movement-evoked pain relief. Most (79.9%) POD cases in IVPCA patients showed either one or two symptoms. The symptoms of POD were ranked from high to low as disorientation (65.7%), illusions/hallucinations (37.1%), inappropriate communication (31.4%), inappropriate behavior (25.7%), and psychomotor retardation (14.2%). Conclusion: The incidence rate of POD in IVPCA patients was low. Further research is warranted concerning POD and IVPCA pain management. Keywords: postoperative delirium, postoperative analgesia, patient-controlled analgesiaLin YTLan KMWang LKChu CCWu SZChang CYChen JYDove Medical Pressarticlepostoperative deliriumpostoperative analgesiapatient controlled analgesiaNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 12, Pp 3205-3212 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	postoperative delirium postoperative analgesia patient controlled analgesia Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	postoperative delirium postoperative analgesia patient controlled analgesia Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Lin YT Lan KM Wang LK Chu CC Wu SZ Chang CY Chen JY Incidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study
description	Yao Tsung Lin,1 Kuo Mao Lan,1 Li-Kai Wang,1 Chin-Chen Chu,1 Su-Zhen Wu,1 Chia-Yu Chang,2 Jen-Yin Chen1,3 1Department of Anesthesiology, 2Department of Neurology, Chi Mei Medical Center, 3Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan Background: Intravenous patient-controlled analgesia (IVPCA) is a common method of relieving pain which is a risk factor of postoperative delirium (POD). However, research concerning POD in IVPCA patients is limited. Objective: We aimed to determine the incidence, risk factors, and phenomenological characteristics of POD in patients receiving IVPCA. Methods: A prospective, cohort study was conducted in post-general anesthesia IVPCA patients aged ≥60 years. POD was measured by the Nursing Delirium Screening Scale (NuDESC; 0–10). Delirium, pain severity at rest and/or on movement, and side effects of IVPCA during 3 postoperative days were examined twice-daily by the acute pain service team. Pain severity is measured by an 11-point verbal numerical rating scale (11-point VNRS) (0–10). An 11-point VNRS >3 was considered inadequate pain relief. If POD (detected by NuDESC ≥1) is suspected, consulting a neurologist or a psychiatrist to confirm suspected POD is required. Results: In total, 1,608 patients were included. The incidence rate of POD was 2.2%. Age ≥70 years and American Society of Anesthesiologists physical status >III were the risk factors of POD in IVPCA patients. Approximately three-quarters of all POD cases occurred within the first 2 postoperative days. For pain at rest, patients with inadequate pain relief had significantly greater rates of POD than patients with adequate pain relief (day 1, 8.4% vs 1.5%, P<0.001; day 2, 9.6% vs 2.0%, P=0.028; day 3, 4.1% vs 2.1%, P=0.412). However, the incidence of POD was not associated with movement-evoked pain relief. Most (79.9%) POD cases in IVPCA patients showed either one or two symptoms. The symptoms of POD were ranked from high to low as disorientation (65.7%), illusions/hallucinations (37.1%), inappropriate communication (31.4%), inappropriate behavior (25.7%), and psychomotor retardation (14.2%). Conclusion: The incidence rate of POD in IVPCA patients was low. Further research is warranted concerning POD and IVPCA pain management. Keywords: postoperative delirium, postoperative analgesia, patient-controlled analgesia
format	article
author	Lin YT Lan KM Wang LK Chu CC Wu SZ Chang CY Chen JY
author_facet	Lin YT Lan KM Wang LK Chu CC Wu SZ Chang CY Chen JY
author_sort	Lin YT
title	Incidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study
title_short	Incidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study
title_full	Incidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study
title_fullStr	Incidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study
title_full_unstemmed	Incidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study
title_sort	incidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/5dc812f3add84e5fb580d9fb12ca9d3e
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Incidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study

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