Influence of preoperative emotional state on postoperative pain following orthopedic and trauma surgery

Robleda, Gemma; Sillero-Sillero, Amalia; Puig, Teresa; Gich, Ignasi; Baños, Josep-E

doi:10.1590/0104-1169.0118.2481

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Original Articles • Rev. Latino-Am. Enfermagem 22 (5) • Sep-Oct 2014 • https://doi.org/10.1590/0104-1169.0118.2481 linkcopy

Influence of preoperative emotional state on postoperative pain following orthopedic and trauma surgery

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVES: to analyze the relationship between preoperative emotional state and the prevalence and intensity of postoperative pain and to explore predictors of postoperative pain.

METHOD: observational retrospective study undertaken among 127 adult patients of orthopedic and trauma surgery. Postoperative pain was assessed with the verbal numeric scale and with five variables of emotional state: anxiety, sweating, stress, fear, and crying. The Chi-squared test, Student's t test or ANOVA and a multivariate logistic regression analysis were used for the statistical analysis.

RESULTS: the prevalence of immediate postoperative pain was 28%. Anxiety was the most common emotional factor (72%) and a predictive risk factor for moderate to severe postoperative pain (OR: 4.60, 95% CI 1.38 to 15.3, p<0.05, AUC: 0.72, 95% CI: 0.62 to 0.83). Age exerted a protective effect (OR 0.96, 95% CI: 0.94-0.99, p<0.01).

CONCLUSION: preoperative anxiety and age are predictors of postoperative pain in patients undergoing orthopedic and trauma surgery.

Pain, Postoperative; Anxiety; Surgery; Orthopedics

Variable			n	%	Mean	Standard Deviation
Gender
	Women		79	62
	Men		48	38
Age, years					71	18
	Women				77	13
	Men				60,5	20
American Society of Anesthesiologists					2.3	0.7
	I		14	11
	II		60	47
	III		50	40
	IV		2	2
Operating time, min					128	53.5
	≤90 min		89	70
	>90 min		38	30
Type of anesthesia
	General		20	15
	Combined		21	17
	Regional		86	68
Type of surgery
	Trauma surgery (fractures)		76	60
	Prosthetic surgery		51	40
		Knee replacement surgery	26	20
		Hip replacement surgery	20	16
		Shoulder replacement surgery	5	4
Medical record
	Diabetes mellitus		27	21
	Heart disease		64	50
	Chronic obstructive pulmonary disease		14	11
	Previous surgery		84	66
	Previous disease with chronic pain		35	44
	Usual pain medication		30	38
	Anxiety / depression		9	12

Intensity	% (n) with pain
	Mean (standard deviation)	Total pain*	95% CI	Mild	Moderate to severe
	Mean (standard deviation)	n (%)	n (%)	n (%)	n (%)
Admission to the PCU	1 (1.2)	28 (36)	21 – 35	15 (20)	13 (16)
Average stay in the PCU	1.2 (1.3)	61 (77)	53 - 68	54 (67)	6.5 (10)
Pain at 12 hours	2.2 (2.4)	56 (71)	46.5 – 64.5	35 (45)	21 (27)
Pain at 24 hours	1.7 (2.3)	46 (59)	37 – 53.5	28 (36)	18 (23)

	Pain (n=36)	No pain (n=91)	P
	n (%)	n (%)
Anxiety	32 (89)	60 (66)	<0.01
Sweating	16 (44)	24 (26)	0.06
Stress	23 (64)	52 (57)	0.55
Fear	26 (72)	61 (67)	0.67
Crying	3 (8)	6 (7)	0.71
Total	33 (92)	70 (77)	0.28

		OR*	95% CI	p
Bivariate analysis
	Age	0.962	0.940 – 0.985	<0.001
	General anesthesia	4.617	1.660 – 12.840	<0.05
	Combined anesthesia	1.619	0.545 – 4.808	<0.01
	Comorbidity: heart disease	3.043	1.332 – 6.953	<0.01
	Preoperative anxiety	4.592	1.382 – 15.262	<0.05
	Preoperative sweating	2.351	1.044 – 5.296	<0.05
Multivariate analysis
	Age	0.962	0.940 – 0.985	<0.001
	Preoperative anxiety	4.592	1.382 – 12.34	<0.05

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Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
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Total pain = NRS>1; Mild = NRS of 1-3; Moderate-to-severe = NRS>4