Influence of Preoperative Anxiety Level on Postoperative Pain After Cardiac Surgery

Muhammad Kashif,Amir Raza,Mohammad Hamid

doi:10.7759/cureus.22170

Abstract

BackgroundPreoperative anxiety is generally neglected in the evaluation of cardiac surgery patients due to various reasons including insufficient literature and lack of simple assessment tools. In addition to this, the association between anxiety and postoperative complications including pain has been scarcely studied. The present study was designed to assess preoperative anxiety levels in all patients coming for cardiac surgery and then evaluate the effect of different levels of anxiety on postoperative pain scores.MethodsThis prospective cohort study was conducted in a single university hospital from March 2018 to December 2019. One hundred consecutive cardiac surgery patients between the ages of 18-65 years were enrolled in this study. The level of preoperative anxiety (assessed by State Anxiety Inventory) and its effect on postoperative pain and morphine consumption was assessed.ResultsThe average age of the patients was 58.24±10.03 years of which 68% were male and 32% were female. Preoperative mild anxiety was observed in 64% of patients and moderate to severe anxiety in 36% of patients. Post-operative mean pain score was significantly high in the moderate to severe anxiety group as compared to the mild anxiety group [Mean pain difference =1.64 (95%CI: 1.38-1.89) p=0.0005], [Mean pain difference =0.51 (95%CI: 0.29-0.73) p=0.0005] at 12 hours and 24 hours respectively. Intraoperative and postoperative morphine consumption was significantly high in patients with moderate to severe anxiety.ConclusionsPatients with moderate to severe anxiety before cardiac surgery experienced higher pain scores at a post-operative period which is significantly different from the mild anxiety group. Intraoperative and postoperative analgesic requirements were also significantly increased.

Highlights

Anxiety is defined as a negative or life-threatening emotion that one feels generally in the ong-term or in a specific situation, that fluctuates over time [1]
Post-operative mean pain score was significantly high in the moderate to severe anxiety group as compared to the mild anxiety group [Mean pain difference =1.64 (95%CI: 1.38-1.89) p=0.0005], [Mean pain difference =0.51 (95%CI: 0.29-0.73) p=0.0005] at 12 hours and 24 hours respectively
Patients with moderate to severe anxiety before cardiac surgery experienced higher pain scores at a postoperative period which is significantly different from the mild anxiety group

Summary

Introduction

Anxiety is defined as a negative or life-threatening emotion that one feels generally in the ong-term or in a specific situation, that fluctuates over time [1]. Surgery and hospitalization are considered to be major life changes, causing anxiety regardless of the type of surgery and disease [2]. Preoperative anxiety may have a role in the development of chronic postoperative pain, but more studies are needed [7, 8]. Prevalence of anxiety is probably higher in cardiac surgical patients while on the waiting list [11]. Preoperative anxiety is generally neglected in the evaluation of cardiac surgery patients due to various reasons including insufficient literature and lack of simple assessment tools. The association between anxiety and postoperative complications including pain has been scarcely studied. The present study was designed to assess preoperative anxiety levels in all patients coming for cardiac surgery and evaluate the effect of different levels of anxiety on postoperative pain scores

Methods

Results

Conclusion