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Luque Oliveros M, Morilla Romero de la Osa R. Bupivacaine infiltration for acute postoperative pain management after cardiac surgery. Nurs Crit Care 2021; 27:223-232. [PMID: 33641253 DOI: 10.1111/nicc.12614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite increased attention, acute and persistent post-operative pain are not treated efficiently and interventions against acute pain are therefore of clinical importance and should be welcomed. AIMS AND OBJECTIVES To evaluate the effectiveness of wound infiltration with 0.5% bupivacaine for pain management in the immediate post-operative period in patients that underwent cardiac surgery with sternotomy. DESIGN The study was performed employing a single-centre nonrandomized experimental design to evaluate a prospective cohort of patients recruited from June to December of 2017. METHODS A single-centre study with a non-randomized experimental design compared the pain perceived by 137 patients undergoing to cardiac surgery within which 68 patients who received infiltration of bupivacaine and 69 patients received infiltration with saline solution. Pain measures were made with the numeric rating scale (NRS) at 2, 12, 24, and 48 hours. Socio-demographic and clinical variables were included too and descriptive, bivariate, and multivariate logistic regression analyses were performed. RESULTS A statistically significant difference was found between the means of the NRS scores in favour of the intervention group. Cohen's d showed a significant effect size. NRS scores were grouped into NRS ≥4 or NRS <4 and similar results were found. Multivariate logistic regression analyses showed the absence of confounding factors that could call results into question. CONCLUSION Subcutaneous infiltration of 0.5% bupivacaine in the surgical site of patients who have undergone cardiac surgery showed clinically and statistically significant pain relief compared with patients who received saline infiltration throughout the first 12 hours after surgery. This intervention provides promising preliminary results that, alone or in conjunction with other nursing interventions, could constitute an important therapeutic tool for this area of nursing clinical practice.
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Affiliation(s)
| | - Rubén Morilla Romero de la Osa
- Departamento de Enfermería, Universidad de Sevilla, Seville, Spain.,Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Consejo Superior de Investigaciones Científicas, Universidad de Sevilla, Seville, Spain
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2
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Anderson M, Parke R, Jull A. Effect of Cardiac Surgery on Health-Related Quality of Life in Patients Aged 75 Years or Older: A Prospective Study. Heart Lung Circ 2020; 30:282-287. [PMID: 32622914 DOI: 10.1016/j.hlc.2020.05.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 02/03/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) of patients, aged 75 years or older, was measured before and at 12 weeks after cardiac surgery using a generic tool (SF12 version 2). METHODS This was a single centre, prospective study of patients aged 75 years or older who had any type of cardiac surgery. The instrument was self-administered preoperatively and by interviewer administered via telephone at 12 weeks. RESULTS Sixty-six (66) of the 81 participants approached were eligible and agreed to participate. Mean age was 79.2 years, 17 participants were female (25.8%), 56 participants were New Zealand European (84.8%) and the mean Euroscore II score was 4.0. Sixty (60) participants (90.9%) provided data at follow-up. All mean HRQoL domain scores significantly improved by 12 weeks after surgery. The pattern of gain was similar for ages 75-79 and 80 years and older. The changes in the physical and mental component summary (PCS, MCS) scores were statistically significant and the mean scores were proximate to or better than age group norms at 12 weeks. The number of patients with a PCS score at or above age group norms improved from 16.4% to 56.6% while the number of patients whose MCS scores were at or above age group norms improved from 55.7% to 81.6%. Health utility values also significantly improved. CONCLUSIONS Cardiac surgery in older patients is associated with significantly improved physical and mental health-related quality of life at 12 weeks after procedure.
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Affiliation(s)
- Maxine Anderson
- Auckland City Hospital, Auckland, New Zealand; School of Nursing, University of Auckland, New Zealand.
| | - Rachael Parke
- Auckland City Hospital, Auckland, New Zealand; School of Nursing, University of Auckland, New Zealand
| | - Andrew Jull
- Auckland City Hospital, Auckland, New Zealand; School of Nursing, University of Auckland, New Zealand
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Salazar A, Dueñas M, Fernandez-Palacin F, Failde I. Factors related to the evolution of Health Related Quality of Life in coronary patients. A longitudinal approach using Weighted Generalized Estimating Equations with missing data. Int J Cardiol 2016; 223:940-946. [PMID: 27597157 DOI: 10.1016/j.ijcard.2016.08.300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/19/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim is to know the factors related to the evolution of Health Related Quality of Life (HRQL) in Coronary Patients (CP) from a longitudinal perspective using an appropriate method that handles missing data adequately when the mechanism of missingness is uncertain. METHODS Prospective study with repeated measures at baseline, 3 and 6months. 250 patients with acute myocardial infarction or unstable angina were studied. Sociodemographic and clinical data were collected at baseline. Mental health (GHQ-28) and HRQL (SF-36v1) were assessed during the follow-up. The missingness mechanism was tested. Friedman test and partial eta-squared were used to analyse changes in SF-36 scores and WGEE were used to identify the predictors of the evolution of HRQL. RESULTS 95 dropped out after 3months and 72 after 6months. The missingness was likely to be at random. All the dimensions of the SF-36 improved over time, except PF. The factors related to the evolution of HRQL were: being woman (B=-23.9 in RE; B=-6.9 in MCS), older age (B=-0.5 in BP; B=-0.3 in VT), being single/separated (B=-14.5 in GH; B=-14.1 in SF; B=-23.3 in MH) and widow(er) (B=-23.2 PF; B=-29.8 in SF), hypertensive (B=-19.8 in RP; B=-8.9 in VT), worse mental health (B=-3 in PF; B=-2.8 in RP; B=-3.1 in BP; B=-1.2 in PCS; B=-3.8 in VT; B=-2.6 in SF), previous history of CHD (B=-12.5 in PF; B=-5.2 in PCS), and performing heart-healthy physical activities (B=13.9 in PF). CONCLUSIONS HRQL improves over time. A global approach, including age, marital status, performing physical activities or hypertension, is required to improve HRQL in CP.
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Affiliation(s)
- A Salazar
- Department of Biomedicine, Biotechnology and Public Health, University of Cádiz, Cádiz, Spain.
| | - M Dueñas
- Salus Infirmorum Faculty of Nursing, University of Cádiz, Spain
| | - F Fernandez-Palacin
- Department of Statistics and Operational Research, University of Cádiz, Cádiz, Spain
| | - I Failde
- Department of Biomedicine, Biotechnology and Public Health, University of Cádiz, Cádiz, Spain
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Thorsteinsson K, Andreasen JJ, Mortensen RN, Kragholm K, Torp-Pedersen C, Gislason G, Køber L, Fonager K. Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery: a nationwide cohort study. Interact Cardiovasc Thorac Surg 2016; 22:792-8. [PMID: 26969738 DOI: 10.1093/icvts/ivw045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/26/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Data on nursing home admission in patient's ≥80 years after isolated coronary artery bypass grafting (CABG) are scarce. The purpose of this study was to evaluate longevity and subsequent admission to a nursing home stratified by age in a nationwide CABG cohort. METHODS All patients who underwent isolated CABG from 1996 to 2012 in Denmark were identified through nationwide registers. The cumulative incidence of admission to a nursing home after CABG was estimated. A Cox regression model was constructed to identify predictors for living in a nursing home 1 year after CABG. Kaplan-Meier estimates were used for survival analysis. Subanalysis on home care usage was performed in the period 2008-2012. RESULTS A total of 38 487 patients were included. The median age was 65.4 ± 9.5 years (1455 > 80 years) and 80% were males. The 30-day mortality rate was 2.8%, increasing with age (1.2% in patients <60 years and 7.8% in patients ≥80 years). The mortality rate at 1 year was 2.2% among patients aged <60 and 14.1% among patients ≥80 years. At the 1-year follow-up, 4.2% of patients <60 years, 7.9% of patients 60-70 years, 14.4% of patients 70-74 years, 18.5% of patients 75-79 years and 29.1% of patients ≥80 years had received home care. The proportion of patients admitted to a nursing home at 1, 5 and 10 years after CABG was 0.1, 0.4 and 1.0% (<60 years), and 1.4, 7.5 and 16.8% (≥80 years), respectively. Main predictors for living in a nursing home 1 year postoperatively were: age ≥80 years [hazard ratio (HR) 17.8, 95% confidence interval (CI) 7.4-42.8], female sex (HR 1.7, 95% CI 1.1-2.6), previous heart failure (HR 1.6, 95% CI 1.0-2.4), previous myocardial infarction (HR 2.0, 95% CI 1.3-3.2) and previous stroke (HR 3.3, 95% CI 2.1-4.9). Neither urgent nor emergency surgeries were significant predictors for living in a nursing home 1 year postoperatively. CONCLUSIONS The majority of all patients selected for CABG surgery in Denmark between 1996-2012, including the elderly, were able to live independently at home without the need of home care for many years after CABG. The risk of nursing home admission was small and dependent on the patient's age, sex and preoperative comorbidities.
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Affiliation(s)
- Kristinn Thorsteinsson
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jan J Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rikke N Mortensen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Kragholm
- Department of Anesthesiology and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark The Danish Heart Foundation, Copenhagen, Denmark The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Fonager
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
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Affiliation(s)
- Leonard Shan
- Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria (L.S., A.S., A.N.); Cardiology Unit, South Eastern Sydney and Illawarra Health Network, Wollongong, NSW (A.S., R.M.); and University of Melbourne Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia (A.N.)
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Affiliation(s)
- Silke Apers
- Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Koen Luyckx
- School Psychology and Child and Adolescent Development, KU Leuven, Belgium
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Belgium
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- The Heart Centre, Copenhagen University Hospital, Denmark
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Apers S, Luyckx K, Moons P. How meaningful is sense of coherence to cardiovascular nursing? Eur J Cardiovasc Nurs 2012; 11:375-7. [DOI: 10.1177/1474515112452354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Silke Apers
- Department of Public Health, Centre for Health Services and Nursing Research, KU Leuven – University of Leuven, Leuven, Belgium
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, School Psychology and Child and Adolescent Development, KU Leuven – University of Leuven, Leuven, Belgium
- Research Foundation Flanders, Belgium
| | - Philip Moons
- Department of Public Health, Centre for Health Services and Nursing Research, KU Leuven – University of Leuven, Leuven, Belgium
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
- The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
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van Valen R, van Vuuren H, van Domburg RT, van der Woerd D, Hofland J, Bogers AJJC. Pain management after cardiac surgery: experience with a nurse-driven pain protocol. Eur J Cardiovasc Nurs 2012; 11:62-9. [DOI: 10.1177/1474515111430879] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Richard van Valen
- Department of Cardio-Thoracic Surgery, Erasmus Medical Center, the Netherlands
| | | | | | | | - Jan Hofland
- Department of Anesthesiology, Erasmus Medical Center, the Netherlands
| | - Ad JJC Bogers
- Department of Cardio-Thoracic Surgery, Erasmus Medical Center, the Netherlands
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