Abstract
ABSTRACT Objectiv:e to analyze the relationship of anxiety and depression in the preoperative period with the presence of pain in the postoperative period. Method: cohort study conducted at a university hospital in the state of Minas Gerais (Brazil), between february and July 2017, with 65 patients. A collection instrument was elaborated for the demographic and clinical characteristics. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression; pain intensity was measured using the Verbal Numerical Scale. Data were submitted to descriptive and inferential statistical analysis. Results: according to demographic and clinical characteristics, most patients were female, with a median age of 44 years and surgical specialty of the digestive tract. In the preoperative period, 31 (47.7%) had anxiety, and nine (13.8%), depression. None of the patients reported pain immediately prior to surgery. The incidence of moderate to severe postoperative pain was 32 (49.2%) patients. There was a statistically significant difference in the distribution of patients with postoperative pain in relation to the presence or absence of preoperative anxiety (p value <0.001). There is no statistically significant difference in the distribution of patients with postoperative pain in relation to the presence or absence of preoperative depression (0.733). In multivariate analysis, preoperative anxiety was a predictive factor for postoperative pain. Depression was not a predictive factor of postoperative pain. Conclusion: It was demonstrated that, regardless of the demographic and clinical characteristics of the studied sample, the presence of anxiety in patients in the preoperative period is a predictive factor of postoperative pain.
Highlights
IntroductionAmong the conditions that may affect the patient’s recovery after a surgical procedure, pain deserves special attention, as it is a very frequent phenomenon and can result in exposure of patients to unnecessary suffering, as well as having a significant impact on clinical and economic outcomes of health care.[1,2]Pain is considered a predictable phenomenon of surgery, it should be prevented and treated effectively; but despite the therapeutic advances in its control, postoperative prevalence is surprisingly high.[2,3]A research in the United States found that more than 80% of patients undergoing surgical procedures experience pain in the immediate postoperative period, and approximately 75% of people with postoperative pain report its intensity as moderate to severe.[1]A European survey of 746 hospitals found that postoperative pain control was suboptimal; For example, in the Netherlands, 41% of patients undergoing surgery reported moderate or severe pain on day “zero”, 30% on day one, and 19%, 16%, and 14% on postoperative “days 2,3, and 4”.4Nursing care includes being aware of the patients’ subjective complaints, so as to intervene in the course of the symptom, allowing for comfort and well-being
The results present the description of pain assessment in the preoperative and postoperative periods and the relationship of pain with anxiety and depression in the preoperative period
This percentage is higher than those in contemporary studies with similar design, where females range from 30.0% to 72.0%, but it should be noted that these studies were developed in patients of specific surgical specialties, and the distribution by gender depends on the epidemiological profile of each disease.[15,16,17]
Summary
Among the conditions that may affect the patient’s recovery after a surgical procedure, pain deserves special attention, as it is a very frequent phenomenon and can result in exposure of patients to unnecessary suffering, as well as having a significant impact on clinical and economic outcomes of health care.[1,2]Pain is considered a predictable phenomenon of surgery, it should be prevented and treated effectively; but despite the therapeutic advances in its control, postoperative prevalence is surprisingly high.[2,3]A research in the United States found that more than 80% of patients undergoing surgical procedures experience pain in the immediate postoperative period, and approximately 75% of people with postoperative pain report its intensity as moderate to severe.[1]A European survey of 746 hospitals found that postoperative pain control was suboptimal; For example, in the Netherlands, 41% of patients undergoing surgery reported moderate or severe pain on day “zero”, 30% on day one, and 19%, 16%, and 14% on postoperative “days 2,3, and 4”.4Nursing care includes being aware of the patients’ subjective complaints, so as to intervene in the course of the symptom, allowing for comfort and well-being. Pain is considered a predictable phenomenon of surgery, it should be prevented and treated effectively; but despite the therapeutic advances in its control, postoperative prevalence is surprisingly high.[2,3]. A research in the United States found that more than 80% of patients undergoing surgical procedures experience pain in the immediate postoperative period, and approximately 75% of people with postoperative pain report its intensity as moderate to severe.[1]. A European survey of 746 hospitals found that postoperative pain control was suboptimal; For example, in the Netherlands, 41% of patients undergoing surgery reported moderate or severe pain on day “zero”, 30% on day one, and 19%, 16%, and 14% on postoperative “days 2,3, and 4”.4. As pain is measured as a vital sign, there are parameters to establish a good care plan, considering that therapeutic care should be conditioned to pain intensity.[5]
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