The relationship between insomnia and acute postoperative pain: a case-control study on laparoscopic cholecystectomy patients

Abstract

Aims: Psychological factors play a significant role in predicting postoperative pain. However, the impact of insomnia on acute postoperative pain is little known. The aim of this study was to investigate the relationship between insomnia and acute postoperative pain. Methods: We performed a case-control study in patients undergoing elective laparoscopic cholecystectomy. Patients with an Insomnia Severity Index (ISI) score >14 were allocated to an insomnia group (n=35) and those with an ISI score <7 to a control group (n=35). All patients were asked to rate their current level of pain on a numeric rating scale (NRS) at 1, 2, 4, 8, 12, and 18 hours postoperatively. Results: There was no between-group differences in age, gender, body mass index, American Society of Anesthesiologists score, or operating time. The patients in the insomnia group had higher NRS scores and requested significantly greater amounts of tramadol (269.4±33 mg vs. 235.0±36 mg; p<0.001) and rescue analgesia (paracetamol; 1.06±0.8 g vs. 0.40±0.7 g; p<0.001) postoperatively than did the controls. Analysis of covariance revealed a significant interaction between insomnia and the preoperative experience of pain (F=6.62; p=0.013) and significant impact of insomnia on the mean NRS score (F=15.47; p<0.001). Conclusion: Patients who experienced preoperative insomnia and underwent elective cholecystectomy have a reduced threshold for postoperative pain, which increases the need for analgesics.

Keywords

• Insomnia
• sleep disorder
• postoperative pain
• pain threshold predictor
• cholecystectomy

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