Incidência e fatores preditores da dor pós-operatória em crianças submetidas à cirurgias ambulatoriais em Goiânia, Goiás: uma coorte prospectiva
Data
2014-04-24
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Universidade Federal de Goiás
Resumo
Postoperative pain (POP) is still common, especially after hospital discharge, even
when advanced anesthetic and surgical techniques are adopted in pediatric
outpatient surgeries. An additional concern is the intensity of POP, which may vary
from moderate to severe, despite the availability of evidence guiding clinical practice.
This study’s objective was to analyze the incidence of POP and factors predicting this
experience among 5 to 12 year old children undergoing outpatient surgeries. A
prospective cohort study was conducted in two hospitals in Goiania, Brazil between
April 2013 and February 2014 with a sample of 306 children, both genders, aged
from 5 to 12 years old, ASA below III and indication of outpatient surgeries level I.
Data were collected in pre, trans, immediate postoperative (IPO) and in the mediate
postoperative (MPO). The intensity and quality of POP were assessed using the
FPS-R scale and quality cards pain, respectively. Anxiety was assessed through
EAPY-m. Children verbally consented to the study and their legal guardians signed
free and informed consent forms. Cox regression was used in the statistical analysis
to assess the effect of variables on the progress of POP on the seventh day after
surgery. SPSS version 21.0 was used. Male children aged 7.43 years old on average
(sd=2.09) with an average socioeconomic level were the majority. A total of 39.9%
reported pre-operatory pain and 48.2% presented signs of anxiety. The most
frequent surgeries included inguinal hernia repair (48.4%), umbilical hernia repair
(20.7%), postectomy (11.3%), orchidopexy (8.6%) and epigastric hernia repair
(8.6%). Most children received inhalational anesthesia with halothane, local
anesthetic block with 0.5% of bupivacaine, and analgesia with intramuscular
dipyrone. The cumulative incidence of POP was 76.8% (CI95%:71.6%-81.1%).
During IPO, the incidence of pain was 38.9% (CI95%:33.0%-44.9%) and the intensity
was mild. There was report of moderate pain (5.2%), intense pain (2.3%), and the
worst pain possible (7.2%). The incidence of pain during MPO (1
st
day at home) was
39.2% (CI95%:33.8%-45.9%) with mild intensity. There was report of moderate pain
(3.6%), intense (3.6%) and the worst pain possible (4.0%). The incidence diminished
on the 4
th
day to 1.5% (CI95%:0.4%-3.3%), and the intensity of pain remained mild.
There was report of moderate pain (1.5%) and the worst pain possible (0.4%). No
new cases were identified on the 7
th
day. A total of 10.7% (n=28) of the children
experienced pain up to the 7
th
day postoperative. There was report of moderate pain
(0.8%) and intense pain (0.4%). Over the course of follow-up, children described
POP through sensory, affective and evaluative descriptors. The variable preoperatory pain remained as a predictor factor for POP, increasing by three (3) times
the risk of pain on the 7
th
postoperative day (p=0.018). POP is still common among
children undergoing outpatient surgeries. The management of preoperative pain may
prevent persistent postoperative pain.
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MOURA, Louise Amália de. Incidência e fatores preditores da dor pós-operatória em crianças submetidas à cirurgias ambulatoriais em Goiânia, Goiás: uma coorte prospectiva, 2014.114 f. Dissertação (Mestrado em Enfermagem) - Universidade Federal de Goiás, Goiânia, 2014.