Comparative Analysis of Different Methods of Pain Management for Elderly Patients in the Surgical Intensive Care Unit

作者：Huang Becki Wan Yu; Kuo Benjamin Ing Tiau; Chen Chien Chuan; Chang Wen Han; Sun Fang Ju; Yen David Hung Tsang^*

来源：International Journal of Gerontology, 2017, 11(3): 186-190.

DOI：10.1016/j.ijge.2017.04.002

• aged
• pain management
• patient-controlled analgesia
• patient satisfaction
• surgical intensive care

Background: With technological advancements, more elderly patients are undergoing surgery and require care from surgical intensive care units. We aimed to determine the pain management method that provides better acute pain control in all-cause elderly surgical intensive care unit patients.
Methods: This retrospective cohort study included a chart review of patients treated in a 26-bed surgical intensive care unit from April 2011 through September 2012. The patient exclusion criteria were as follows: unconscious, uncooperative, < 65 years, post-brain surgery, or had an American Society of Anesthesiologists classification < III. The primary aim was to compare visual analogue scale (0e100) scores between three different methods of pain management. The secondary endpoints were patient satisfaction and determinants of patient satisfaction.
Results: We evaluated 580 patients. The average age was 76 years, and 57% were male. At rest, the patient-controlled epidural analgesia group exhibited significantly lower pain scores (12.06 +/- 9.53) compared with the other two groups. During movement, the patient-controlled epidural analgesia and pethidine/nonsteroidal anti-inflammatory drugs groups showed no difference; both exhibited lower pain scores than the patient-controlled analgesia group (41.38 +/- 12.5). While coughing, the pethidine/ nonsteroidal anti-inflammatory drugs group exhibited lower scores (39.67 +/- 24.50) than the patientcontrolled epidural analgesia and patient-controlled analgesia groups. The patient-controlled epidural analgesia group showed highest patient satisfaction (4.27 +/- 0.51). Stepwise multiple linear regression analysis revealed that patient satisfaction was associated with patient-controlled epidural analgesia (positively) and T-piece trial (negatively).
Conclusion: Patient-controlled epidural analgesia appears to be a better choice for acute pain management for all-cause elderly surgical intensive care unit patients.

• 出版日期2017-9