Evaluating Pain, Opioids, and Delirium in Critically Ill Older Adults

Abstract

Untreated pain and pain management with opioids are independent precipitating factors for delirium. This retrospective study evaluated the relationships among pain severity, its management with opioids, and the onset of delirium in older adult patients admitted to the surgical intensive care unit (SICU). Consecutive patients aged 65 or greater admitted to the SICU over a 5-month period were examined ( n = 172). When assessed using a multivariable general estimating equation model, opioids (chi-square [χ2], 12.34, p = .0004), but not pain (χ2, 3.31, p = .0688) were significant in predicting next-day delirium status. Controlling for pain, patients exposed to opioids were 2.5 times more likely to develop delirium than patients not exposed (95% Confidence Interval: 1.44–4.36). Our data shows that opioid administration predicted the onset of next-day delirium. In an effort to prevent delirium, future research should focus on opioid-sparing pain management approaches to mitigate pain and delirium.

Current Perspectives on the Assessment and Management of Pain in the Intensive Care Unit

“…Untreated pain has been associated with higher rates of delirium; [60][61][62][63][64] however, the overuse of opioids and particularly benzodiazepines have been associated with increased delirium. [65][66][67] This supports the analgosedation approach, in which the lowest possible dose to achieve target effect is recommended, and benzodiazepines in general should be avoided for sedation as they are strongly associated with delirium. 3,10,22…”

Anesthesia without opioids

“…The opioid-sparing approach has been suggested to be the best intervention to prevent the development of opioid-associated delirium. 18 A lower incidence of postoperative ileus and a shorter duration of hospital stay have also been observed with the use of opioids sparing liposomal bupivacaine. 19 When it comes to postoperative pain outcomes, opioid-inclusive anaesthesia does not show much of an advantage over opioid-free techniques.…”

The complications of opioid use during and post–intensive care admission: A narrative review

“…Pain and opioid use are two potential causal factors for the development of delirium. [36][37][38][39] Given the pathophysiology of ICU delirium is complex, it is unsurprising that there is no clear role of opioids in its development. While numerous studies confer a positive association between opioid use in the ICU and ICU delirium, 36,37,[39][40][41] several other studies have found no association.…”

“…[36][37][38][39] Given the pathophysiology of ICU delirium is complex, it is unsurprising that there is no clear role of opioids in its development. While numerous studies confer a positive association between opioid use in the ICU and ICU delirium, 36,37,[39][40][41] several other studies have found no association. 38,42,43 However, it is plausible that both opioid dose and type may play a role in the development of delirium in the ICU.…”