Dor no pós-operatório de cirurgia cardíaca por esternotomia

• Main Author: LIMA, Luciano Ramos de
• Publication Date: 2009
• Format: Master thesis
• Language: por
• Source: Repositório Institucional da UFG
• Download full: http://repositorio.bc.ufg.br/tede/handle/tde/700
• topic: Dor pós-operatória; Cirurgia cardíaca; Medição da dor; Analgésicos; Avaliação em enfermagem; Ansiedade; 1.Dor pós-operatória 2.Cirurgia cardíaca 3.Medição da dor 4.Analgésicos 5.Avaliação em enfermagem 6.Ansiedade; Pain postoperative; Thoracic Surgery; Pain Measurement; Analgesics; Nursing Assessment; Anxiety; CNPQ::CIENCIAS DA SAUDE::ENFERMAGEM

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 &#945; = 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.