Review of analgesia use in the intensive care unit after heart surgery

Objective: To investigate analgesic prescription patterns and administration in postoperative cardiac surgery patients in the ICU in a tertiary hospital. Method: The audit was registered with the institutional Quality Improvement Committee. A sample of 73 postcardiac surgery patients who were admitt...

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Main Authors: Coventry, Linda, Siffleet, J., Williams, Anne
Format: Journal Article
Published: Australasian Medical Publishing Co 2006
Online Access:http://search.informit.com.au/fullText;dn=517500178558143;res=IELHEA
http://hdl.handle.net/20.500.11937/30018
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author Coventry, Linda
Siffleet, J.
Williams, Anne
author_facet Coventry, Linda
Siffleet, J.
Williams, Anne
author_sort Coventry, Linda
building Curtin Institutional Repository
collection Online Access
description Objective: To investigate analgesic prescription patterns and administration in postoperative cardiac surgery patients in the ICU in a tertiary hospital. Method: The audit was registered with the institutional Quality Improvement Committee. A sample of 73 postcardiac surgery patients who were admitted to the ICU duri.ng a 12-month period in 2003-2004 were reviewed. Results: All patients received opioid analgesia in the ICU. On the first postoperative day, patients received a mean of 1.27 mg morphine equivalents per hour, while the 25 patients present in the ICU for a second day received a mean of 0.84 mg morphine equivalents per hour. No relationship was seen between Day 1 administration of analgesia and age, sex or use of an internal mammary artery (IMA) graft or Day 2 administration and sex or use of IMA. A slight negative relationship existed between morphine administered on Day 2 and age (r=0.38, P=0.06). Paracetamol or paracetamol plus codeine (8 mg or 30 mg) was administered to 70 patients (96%), but was prescribed 6-hourly in 24 patients (33%) and actually administered 6hourly in 32 (44%). No analgesia was administered in 23% of patients before removal of chest drains. The average time to extubation was 15.7 h (SD, 12.1 h). A moderate correlation between time to extubation and morphine equivalents per hour on Day 1 was demonstrated (r= 0.43, P< 0.001). The average duration of ICU stay was 28.1 h. A routine pain assessment score was not charted for any the 73 patients. Conclusion: We recommend introducing scoring of patient pain in the ICU, both at rest and with movement, and provision of a designated area on the ICU flow chart for these scores. Paracetamol or other simple analgesics could be prescribed regularly, and staff need education about premedication of patients before removal of chest drains.
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spelling curtin-20.500.11937-300182017-01-30T13:16:48Z Review of analgesia use in the intensive care unit after heart surgery Coventry, Linda Siffleet, J. Williams, Anne Objective: To investigate analgesic prescription patterns and administration in postoperative cardiac surgery patients in the ICU in a tertiary hospital. Method: The audit was registered with the institutional Quality Improvement Committee. A sample of 73 postcardiac surgery patients who were admitted to the ICU duri.ng a 12-month period in 2003-2004 were reviewed. Results: All patients received opioid analgesia in the ICU. On the first postoperative day, patients received a mean of 1.27 mg morphine equivalents per hour, while the 25 patients present in the ICU for a second day received a mean of 0.84 mg morphine equivalents per hour. No relationship was seen between Day 1 administration of analgesia and age, sex or use of an internal mammary artery (IMA) graft or Day 2 administration and sex or use of IMA. A slight negative relationship existed between morphine administered on Day 2 and age (r=0.38, P=0.06). Paracetamol or paracetamol plus codeine (8 mg or 30 mg) was administered to 70 patients (96%), but was prescribed 6-hourly in 24 patients (33%) and actually administered 6hourly in 32 (44%). No analgesia was administered in 23% of patients before removal of chest drains. The average time to extubation was 15.7 h (SD, 12.1 h). A moderate correlation between time to extubation and morphine equivalents per hour on Day 1 was demonstrated (r= 0.43, P< 0.001). The average duration of ICU stay was 28.1 h. A routine pain assessment score was not charted for any the 73 patients. Conclusion: We recommend introducing scoring of patient pain in the ICU, both at rest and with movement, and provision of a designated area on the ICU flow chart for these scores. Paracetamol or other simple analgesics could be prescribed regularly, and staff need education about premedication of patients before removal of chest drains. 2006 Journal Article http://hdl.handle.net/20.500.11937/30018 http://search.informit.com.au/fullText;dn=517500178558143;res=IELHEA Australasian Medical Publishing Co restricted
spellingShingle Coventry, Linda
Siffleet, J.
Williams, Anne
Review of analgesia use in the intensive care unit after heart surgery
title Review of analgesia use in the intensive care unit after heart surgery
title_full Review of analgesia use in the intensive care unit after heart surgery
title_fullStr Review of analgesia use in the intensive care unit after heart surgery
title_full_unstemmed Review of analgesia use in the intensive care unit after heart surgery
title_short Review of analgesia use in the intensive care unit after heart surgery
title_sort review of analgesia use in the intensive care unit after heart surgery
url http://search.informit.com.au/fullText;dn=517500178558143;res=IELHEA
http://hdl.handle.net/20.500.11937/30018