Analgesics prescribed and administered to intensive care cardiac surgery patients: does patient age make a difference?

This study was conducted to determine the effects of patient age on the opioid prescription and administration practices of professionals in a sample of 80 cardiac surgery patients. The age categories were patients < 65 years of age and patients > or = 65 years of age. Medical records of adult cardiac surgery patients undergoing valve replacements and coronary artery bypass surgery within a single metropolitan teaching hospital were reviewed. Data were collected for up to three days or until the patient was discharged from the intensive care unit (ICU). For each of the study days, the specific types of opioids prescribed and administered were recorded. Calculations were performed to determine the maximum amounts of opioids prescribed and administered during the study period and to analyze for differences between the two age groups. Analyses revealed that all patients received small amounts of opioid analgesics during their three ICU days: mean = 9.4 mg, day of surgery; mean = 13.3 mg, postoperative day one; mean = 12.1 mg, postoperative day 2. When the total patient sample was evaluated, a significant difference in the doses of opioids prescribed versus administered was found across all three study days. Differences in amounts of opioids administered to the two age groups progressively increased across the three days, with patients > or = 65 receiving less than patients < 65. These differences approached significance on postoperative days one and two. The findings that elderly patients received less opioids than younger patients and that these differences became greater over time is intriguing. Questions remain as to whether ICU patients in pain are under-medicated and whether postsurgical pain control is effective over time.