Avaliação da dor em pós-operatório de cirurgia cardíaca

Postoperative Pain Management in Coronary Artery Bypass Grafting: An Integrative Review

PURPOSE

To identify pharmacological and nonpharmacological interventions adopted for pain relief in the postoperative period of coronary artery bypass graft surgery.

DESIGN

Integrative review.

METHODS

Studies published in English, Spanish, and Portuguese from January 2010 to December 2019 in Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin American and Caribbean Literature on Health Science, PubMed, and Web of Science. Two hundred studies were identified and eleven were included. Methodological analysis was performed using the Medical Education Research Study Quality Instrument.

FINDINGS

The studies found were organized into three thematic categories: pharmacological interventions (methadone, morphine, lidocaine gel, remifentanil, sufentanil, and nefopam), nonpharmacological interventions (low-level laser therapy, light-emitting diode, Class IV laser, and transcutaneous nerve stimulation) and anesthetic techniques (dexmedetomidine, ultrasound-guided pectoral nerve block, high thoracic epidural analgesia, and perioperative parasternal block with levobupivacaine).

CONCLUSIONS

A greater tendency to use drug strategies for postoperative pain relief was identified. The drugs used demonstrated efficacy and safety in the treatment of pain, with the exception of nefopam, which showed little benefit in this population. Nonpharmacological interventions, used as adjuvants to drug treatment, were shown to be safe, effective, and well tolerated by the patients.

Effect of listening to music on anxiety, pain, and cardiorespiratory parameters in cardiac surgery: study protocol for a randomized clinical trial

Background

Preoperative anxiety and postoperative pain are frequent in cardiac surgeries and constitute important stressors for patients, which can cause several complications. One strategy that aims to alleviate these phenomena is listening to music as a non-pharmacological intervention. The aim of this study is to evaluate the effect of listening to music on preoperative state-anxiety, postoperative pain, at rest and when instructed to cough, and cardiorespiratory parameters in patients undergoing cardiac surgery.

Methods

A randomized, parallel, simple masking clinical trial will be conducted with patients 18 years of age or older who have undergone elective cardiac surgery by sternotomy, who agree to participate in the research and sign a free and informed consent form. Study participants will be randomly divided, in a 1:1 ratio, to one of the two groups: experimental (subjected to listening to music for 20 min in the pre- and postoperative period) or control (standard care in the pre- and postoperative period), using a randomization scheme generated by the Randomization.com website. The sample size calculation was obtained after conducting a pilot study.

Discussion

The results of the study may contribute to the implementation of non-pharmacological interventions in health services, highlighting the protocols for listening to music, to minimize anxiety and pain in cardiac surgery.

Trial registration

ReBEC RBR-8mdyhd. Posted on December 10, 2019

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06233-9.

Evaluation of Acute Pain in Patients Undergoing Total Hip Arthroplasty: A Cohort Study

PURPOSE

To evaluate pain levels in patients who underwent total hip arthroplasty (THA) using the Nursing Outcomes Classification (NOC).

METHODS

Prospective cohort study conducted in the surgical hospitalization units of a university hospital in southern Brazil. Twenty-four patients were evaluated and followed-up for four consecutive days after THA.

FINDINGS

A significant difference was found between the first and last evaluations for the outcome pain level (2102). Two indicators also showed statistically significant differences overtime.

CONCLUSIONS

The NOC outcome and indicators demonstrated the different pain levels of patients who underwent THA.

IMPLICATIONS FOR NURSING PRACTICE

The NOC system is applicable to clinical practice, because it facilitated the follow-up of patient progression.