E-ISSN 2367-699X | ISSN 2367-7414
 

Research Article 


The Impact of Different Types of Pain Management Modalities on Post-operative Delirium

Narayan Bhetwal, Jeannie Rivers, Thomas Miller, Michael Amendola, Kellenn Cresswell, Adam Sima, Lucretia Wright.

Abstract
Importance: Delirium is a common problem in patients undergoing surgery. Evidence suggests that the type of anaesthesia used and post-operative pain management approach can impact delirium frequency, but there is no consensus on this issue.
Objectives: This study explored the role of peri-operative pain management modalities, including nerve block, in managing postoperative pain and their association with delirium development.
Design: This is a retrospective cohort study of 440 patients who underwent lower limb amputations, and hip and knee arthroplasties between January 2010 and December 2017 were reviewed.
Setting: Charts of patients who underwent surgery and were admitted to the Hunter Holmes McGuire VA Medical Center, Richmond, VA, were reviewed.
Participants: A total of 460 charts were reviewed (20 were excluded) of patients undergoing total hip arthroplasty, above knee amputation, total knee arthroplasty, below-knee amputation and trans metatarsal amputation. As a problem in the post-operative period, delirium had to be clearly stated in the patientís record.
Main outcome: Development of delirium during the post-operative period associated with the different types of pain management strategies.
Results: A total of 60 patients (13.6%) from the 440 studied developed postoperative delirium. Among the different pain management strategies (IV Acetaminophen, gabapentin, oral narcotics, patient-controlled analgesia, and non-steroidal anti-inflammatory drugs), only gabapentin was associated with delirium, demonstrating 2.27 times higher risk (P=0.0085). We also found that prior narcotic use increased the odds of delirium (P=0.0053). Even after controlling for the anaesthesia type (general, local, regional, spinal and epidural), no association between nerve block and delirium was observed (P=0.41).
Conclusion and Relevance: Taking gabapentin post-operatively for pain management, and having a history of ongoing narcotic usage before surgery, were associated with a higher risk of developing delirium. We found no association between nerve block used and the development of delirium.

Key words: Delirium, Post-operative Pain, Gabapentin, Nerve block, Orthopedic Procedures


 
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How to Cite this Article
Pubmed Style

Bhetwal N, Rivers J, Miller T, Amendola M, Cresswell K, Sima A, Wright L. The Impact of Different Types of Pain Management Modalities on Post-operative Delirium. Int J Surg Med. 2021; 7(1): 1-9. doi:10.5455/ijsm.Pain-Management-delirium


Web Style

Bhetwal N, Rivers J, Miller T, Amendola M, Cresswell K, Sima A, Wright L. The Impact of Different Types of Pain Management Modalities on Post-operative Delirium. http://www.ejos.org/?mno=136631 [Access: March 03, 2021]. doi:10.5455/ijsm.Pain-Management-delirium


AMA (American Medical Association) Style

Bhetwal N, Rivers J, Miller T, Amendola M, Cresswell K, Sima A, Wright L. The Impact of Different Types of Pain Management Modalities on Post-operative Delirium. Int J Surg Med. 2021; 7(1): 1-9. doi:10.5455/ijsm.Pain-Management-delirium



Vancouver/ICMJE Style

Bhetwal N, Rivers J, Miller T, Amendola M, Cresswell K, Sima A, Wright L. The Impact of Different Types of Pain Management Modalities on Post-operative Delirium. Int J Surg Med. (2021), [cited March 03, 2021]; 7(1): 1-9. doi:10.5455/ijsm.Pain-Management-delirium



Harvard Style

Bhetwal, N., Rivers, . J., Miller, . T., Amendola, . M., Cresswell, . K., Sima, . A. & Wright, . L. (2021) The Impact of Different Types of Pain Management Modalities on Post-operative Delirium. Int J Surg Med, 7 (1), 1-9. doi:10.5455/ijsm.Pain-Management-delirium



Turabian Style

Bhetwal, Narayan, Jeannie Rivers, Thomas Miller, Michael Amendola, Kellenn Cresswell, Adam Sima, and Lucretia Wright. 2021. The Impact of Different Types of Pain Management Modalities on Post-operative Delirium. International Journal of Surgery and Medicine, 7 (1), 1-9. doi:10.5455/ijsm.Pain-Management-delirium



Chicago Style

Bhetwal, Narayan, Jeannie Rivers, Thomas Miller, Michael Amendola, Kellenn Cresswell, Adam Sima, and Lucretia Wright. "The Impact of Different Types of Pain Management Modalities on Post-operative Delirium." International Journal of Surgery and Medicine 7 (2021), 1-9. doi:10.5455/ijsm.Pain-Management-delirium



MLA (The Modern Language Association) Style

Bhetwal, Narayan, Jeannie Rivers, Thomas Miller, Michael Amendola, Kellenn Cresswell, Adam Sima, and Lucretia Wright. "The Impact of Different Types of Pain Management Modalities on Post-operative Delirium." International Journal of Surgery and Medicine 7.1 (2021), 1-9. Print. doi:10.5455/ijsm.Pain-Management-delirium



APA (American Psychological Association) Style

Bhetwal, N., Rivers, . J., Miller, . T., Amendola, . M., Cresswell, . K., Sima, . A. & Wright, . L. (2021) The Impact of Different Types of Pain Management Modalities on Post-operative Delirium. International Journal of Surgery and Medicine, 7 (1), 1-9. doi:10.5455/ijsm.Pain-Management-delirium