Dor no pós-operatório de cirurgia cardíaca por esternotomia
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Data
2009-06-16
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Universidade Federal de Goiás
Resumo
Postoperative pain is characterized as an acute pain, prevalent inside the hospital
environment, commonly associated with tissue damage. This study had, as a general
objective, the evaluation of post-operative pain in clients who have undergone to
cardiac surgery by sternotomy, according to the occurrence, intensity (measured at
rest and on deep inspiration), location and quality, 1st, 2nd and 3rd. This is a cohort,
prospective study, developed in a general hospital in the countryside of the State of
Goiás, in the period from January to August 2008. Pain intensity was measured by
means of verbal numerical scale (0-10); quality was measured by the McGill Pain
Questionnaire (MPQ-SF), the location was measured by body diagrams, and
preoperative anxiety was measured via STAI (State/Trait Anxiety Inventory).
Numerical vares were explored by descriptive measures of centrality (mean and
median) and dispersion (minimum, maximum, standard deviation). The categorical
variables were explored by simple absolute frequencies and percentages. The
associations between variables were explored using non-parametric association
tests, such as chi-square, Spearman coefficient, Kruskal-Wallis and Mann-Whitney
with α = 5%. 62 clients participated, 56.5% men, 67.7% white, 42% of socioeconomic
class C and 72.6% married. The mean age was 54.8 years, SD = 12.1 years, and
the predominant age group (29.0%) from 51 to 60 years. The prevalent surgery was
valve surgery (46.8%), followed by myocardial revascularization (40.3%). The
postoperative anxiety level was medium to 92.0% of the clients. Pain intensity at rest
and deep inspiration had a decrease as days passed by, (p<0.05), being classified as
mild-moderate (MD [median]=0,0-3,0; Q1 [quartile 1]=0,0-1,0; Q3 [quartile 3]=2,0-6,0;
MAX [maximum]=8,0-10,0; MIN [minimum]=0,0-0,0) at rest and moderate-intense
(MD=2,0-5,0; Q1=0,75-2,75; Q3=3,0-7,25; MAX=9,0-10,0; MIN=0,0-0,0) at deep
inspiration. The chest region was the region in where there was the greatest pain
occurrence in the 4 days of PO (40,3%-53,2%).The words which were most
frequently chosen to describe postoperative pain were tiring/exhaustive (83,9%-
95,2%), painful (88,7%-91,9%), persistent (85,5%-87,1%) and splitting (72,6%-
82,3%). Splitting, was the one which received the greatest attribution (score 3) from
the sensory-discriminative group, in numerical scale (0-3), both at POI as in the 1st
and 2nd PO. The PRI (Pain Rating Index), results from the MPQ-SF, for the sensory
group (PRI-S) , the affective group (PRI-A) and total (PRI-T) showed a reduction in
the scores over the 4 days of PO (p<0.001). The correlation between the pain
intensity and PRI scores in the 4 days of PO was positive and significant both for the
PRI-S (0.52-0.34; p<0.001), and PRI-A (0.52-0.30; p<0.001) as to PRI-T (0.56-0.36;
p<0.001). Postoperative pain at rest intensity was consistent to the one observed in
other studies. However, postoperative pain at deep inspiration is still intense, being
able to generate greatest losses in the clients early recovery. Even tough it isn t
significantly associated to pain intensity, it is stressed that all the clients presented
some degree of anxiety, a natural stimulus which can influence the endogenous pain
modulation system, which may exacerbate the pain. In terms of quality, pain was
described through words from the sensory and affective MPQ group, pointing to the
multidimensionality of the painful experience. It is stressed the importance of the
evaluation/measure and the postoperative pain systematic record as essential items to the adequate relief of this experience in the surgical environment.
Descrição
Palavras-chave
Dor pós-operatória , Cirurgia cardíaca , Medição da dor , Analgésicos , Avaliação em enfermagem , Ansiedade , Pain postoperative , Thoracic Surgery , Pain Measurement , Analgesics , Nursing Assessment , Anxiety , 1.Dor pós-operatória 2.Cirurgia cardíaca 3.Medição da dor 4.Analgésicos 5.Avaliação em enfermagem 6.Ansiedade
Citação
LIMA, Luciano Ramos de. Pain in the postoperative of cardic surgery by sternotomy. 2009. 125 f. Dissertação (Mestrado em Cuidado em Enfermagem) - Universidade Federal de Goiás, Goiânia, 2009.