Elsevier

Pain Management Nursing

Volume 2, Issue 4, December 2001, Pages 132-149
Pain Management Nursing

Original Articles
Measurement of opioid-induced sedation*,**,★

https://doi.org/10.1053/jpmn.2001.25169Get rights and content

Abstract

One of the major side effects of opioid analgesics is sedation. Despite the fact that neither a universal definition nor a gold standard for the measurement of opioid-induced sedation exists, various neurophysiologic and psychomotor measures are used to quantify the sedative effects of opioids. This report reviews the strengths and weaknesses of various approaches that are used to measure opioid-induced sedation. The first section summarizes various neurophysiologic measures (i.e., electroencephalogram, autonomic reflexes, and evoked responses), and the second section reviews psychomotor measures (i.e., visual analog scales, observer assessments, motor performance tests, tests of perceptual processes, tests of information processing, tests of memory, and composite tests) that are used to evaluate the sedative effects of opioids. Implications for future research on opioid-induced sedation are discussed. © 2001 by the American Society of Pain Management Nurses

Section snippets

Neurophysiologic measures

Neurophysiologic measures evaluate changes in the functioning of the CNS at the cellular level, focusing on evaluating changes in levels of consciousness as a proxy for sedation. Consciousness is composed of 2 interrelated domains: arousal and content (Plum & Posner, 1980). Arousal refers to the organism's state of awakeness, whereas content addresses how the organism interprets the environment. Alterations in the arousal component of consciousness can be measured by using the EEG, which

Psychomotor measures

Psychomotor activity depends on the coordinated neuromuscular activities of many parts of the neurologic and musculoskeletal systems. Sensory input must be conveyed accurately to the brain in which the information is processed simultaneously by the cerebral cortex, thalamus, cerebellum, and basal ganglia before appropriate motor responses are initiated. Psychomotor activity depends on the integration of arousal mechanisms and content processing. Whether these 2 aspects of consciousness can be

Discussion

Understanding the sedative effects of opioids is becoming a more urgent concern in managing both acute and chronic pain. With increasing frequency, patients are discharged to home immediately after surgical procedures. The sedative effects of opioids prescribed to control acute postoperative pain may impair patients' ability to both learn and carry out requisite self-care activities, delaying discharge to home. This problem may be of greater concern for elderly patients who are more sensitive

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    • Cited by (0)

    *

    Supported by the Oncology Nursing Foundation, the Department of Defense TriService Nursing Research Program (N96-023) at the Uniformed Services University of the Health Sciences, the University of California San Francisco Center for Symptom Management (NINR P30 NR03927), and the University of California San Francisco Century Club.

    **

    The information or content and conclusions do not necessarily represent the official position or policy of, nor should any official endorsement be inferred by, the TriService Nursing Research Program. The first author is an active duty United States Army Nurse Corps officer. The views of the authors do not purport to reflect the views of the Department of the Army or the Department of Defense.

    ★

    Address correspondence to LTC Stacey Young-McCaughan, PhD, RN, AOCN, Deputy Director, Congressionally Directed Medical Research Programs, United States Army Medical Research and Materiel Command, 1077 Patchel St, Fort Detrick, MD 21702-5024. E-mail: [email protected]

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    Copyright © 2001 American Society of Pain Management Nurses. Published by Elsevier Inc. All rights reserved.