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

doi:10.2147/NDT.S119817

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Title:	Incidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study
Authors:	Lin, Yao Tsung Lan, Kuo Mao Wang, Li-Kai Chu, Chin-Chen Wu, Su-Zhen Chang, Chia-Yu Chen, Jen-Yin
Contributors:	Chia Nan Univ Pharm, Chi Mei Med Ctr, Dept Anesthesiol Chia Nan Univ Pharm, Chi Mei Med Ctr, Dept Neurol Chia Nan Univ Pharm, Dept Senior Citizen Serv Management
Keywords:	postoperative delirium postoperative analgesia patient-controlled analgesia screen
Date:	2016
Issue Date:	2018-01-18 11:40:17 (UTC+8)
Publisher:	Dove Medical Press Ltd
Abstract:	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.
Relation:	Neuropsychiatric Disease and Treatment, v.12, pp.3205-3212
Appears in Collections:	[Dept. of Senior Service and Health Management] Periodical Articles

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