Original Investigation

Implantação de um Protocolo de Manejo de Dor e Redução do Consumo de Opioides na Unidade de Terapia Intensiva: Análise de Série Temporal Interrompida

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Bruno Adler Maccagnan Pinheiro Besen
António Paulo Nassar Júnior
Fábio Holanda Lacerda
Carla Marchini Dias da Silva
Vanessa Tota de Souza
Eliana Vieira do Nascimento Martins
Ana Tarina Alvarez Lopes
Carlos Eduardo Brandão
Lucas Fernandes de Oliveira
Keywords:
Pain, Pain measurement, Analgesics, opioid/ adverse effects, Dipyrone, Intensive care units

Abstract

OBJECTIVE: To evaluate the impact of an opioid-sparing pain management protocol on overall opioid consumption and clinical outcomes.
METHODS: This was a single-center, quasi-experimental, retrospective, before and after cohort study. We used an interrupted time series to analyze changes in the levels and trends of the utilization of different analgesics. We used bivariate comparisons in the before and after cohorts as well as logistic regression and quantile regression for adjusted estimates.
RESULTS: We included 988 patients in the preintervention period and 1,838 in the postintervention period. Fentanyl consumption was slightly increasing before the intervention (? = 16; 95%CI 7 -25; p = 0.002) but substantially decreased in level with the intervention (? = -28; 95%CI -195 -62; p = 0.001) and then progressively decreased (? = - 24; 95%CI -35 -13; p < 0.001). There was an increasing trend in the utilization of dipyrone. The mechanical ventilation duration was significantly lower (median difference: - 1 day; 95%CI -1 - 0; p < 0.001), especially for patients who were mechanically ventilated for a longer time (50th percentile difference: -0.78; 95%CI -1.51 – -0.05; p = 0.036; 75th percentile difference: -2.23; 95% CI -3.47 – -0.98; p < 0.001).
CONCLUSION: A pain management protocol could reduce the intensive care unit consumption of fentanyl. This strategy was associated with a shorter mechanical ventilation duration.

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Original Investigation
Author Biography

Corresponding Author

Bruno Adler Maccagnan Pinheiro Besen, Unidade de Terapia Intensiva, Hospital da Luz - São Paulo (SP), Brasil. Unidade de Terapia Intensiva Clínica, Disciplina de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.

Bruno Adler Maccagnan Pinheiro Besen
Instituto Central, Hospital das Clínicas Faculdade de Medicina, Universidade de São Paulo
Rua Dr. Enéas de Carvalho Aguiar, 255, 6º andar, sala 6.040 CEP: 05403-000 - São Paulo (SP), Brasil
E-mail: brunobesen@yahoo.com.br