The effect of anxiety on postoperative pain expectation and opioid consumption in modified radical mastectomy operations

Year 2019, , 136 - 142, 01.06.2019

Erbin Kandemir Tuğba Aşkın , Tünay Kandemir , Gonca Oğuz Tuncel Süheyla Ünver

https://doi.org/10.21601/ortadogutipdergisi.460385

Abstract

Aim: Breast cancer is
the most common cancer in women and is the second most cause of cancer associated
death. After diagnosis is made, emotional distress, anxiety and depression occurs
in 35-38% of women. High anxiety levels prior to operation increases the sensitivity
and expectation of the patients towrads pain, influencing the severity of postoperative
pain. The aim of the present study was to evaluate the effect of preoperative anxiety
on postoperative pain expectation, postoperative pain and opioid consumption in
patients undergoing modified radical mastectomy.

Material
and Method: 60 female patients between the ages of 18-65 were included in the present
study. Preoperative anxiety was evaluated using State Trait Anxiety Inventory (STAI)
and postoperative pain expectation using Visual Analog Scale (VAS). STAI1 test was
administered at preoperative visit, preoperatively and postoperative 6th hour while
STAI2 was administered at preoeprative visit. Demographic characteristics were questioned.
Postoperative pain levels and overall morphine consumption were recorded.

Results: Postoperative STAI1
values were significantly lower than preoperative visit and preoperative STAI1 values
(p=0.002 - p=0.004). Weak but statistically significant correlation was shown between
preoperative visit STAI1 and STAI2 values. A statistically significant but weak
positive relation was found betwen STAI1 preoperative and STAI1 postoperative 6th
hour values and postoperative VAS (p=0.030; rho=0.280; p=0.003; rho=0.378). Median
postperative pain expectation was found to be 6.0 (min=3.0; max=10.0).

Conclusion: In the present
study, it was demonstrated that high preoparetive anxiety scores are associated
with increased postoperative pain level anxiety stimulations may potentiate pain,
by exerting pain like effect via psychological system. It is our suggestion that,
in special patient groups in which anxiety levels are high, such as breast cancer
patients, planning postoeprative pain management after determining preoperative
anxiety level and other risk factors will increase patient satsisfaction and the
efficacy of analgesia. 

Keywords

Modified radical mastectomy, Anxiety, expectation of pain

Modifiye radikal mastektomi operasyonlarında anksiyetenin postoperatif ağrı beklentisi ve opioid tüketimi üzerine etkisi

Abstract

Amaç: Meme kanseri kadınlarda
en sık görülen ve ikinci sırada yer alan kanser ilişkili ölüm sebebidir. Tanı konulduktan
sonra hastaların %35-38’inde emosyonel distres, anksiyete ve depresyon görülür.
Ameliyat öncesi yüksek anksiyete, hastanın ağrıya karşı olan hassasiyetini ve beklentisini
arttırarak postoperatif ağrının şiddetini etkileyebilir. Bu çalışmadaki amacımız
modifiye radikal mastektomi operasyonu uygulanan hastalarda preoperatif anksiyetenin
postoperatif ağrı beklentisi, postoperatif ağrı ve opioid tüketimi üzerine etkisinin
değerlendirilmesidir.

Gereç
ve Yöntem: Çalışmaya 18-65 yaş arası 60 kadın hasta dahil edildi. Preoperatif anksiyete
Sürekli Durum Anksiyete Envanteri (STAI), postoperatif ağrı beklentisi Visüel Analog
Skala (VAS) kullanılarak değerlendirildi. STAI1 testi preoperatif vizit, preoperatif,
postoperatif 6. saatte, STAI2 ise preoperatif vizitte uygulandı. Demografik özellikler
sorgulandı. Hastaların postoperatif ağrı seviyeleri ve toplam morfin tüketimleri
izlenerek kaydedildi.

Bulgular: Postoperatif STAI1
değerleri, preoperatif vizit ve preoperatif STAI1’den anlamlı düzeyde düşüktü (p=0,002
- p=0,004). Preoperatif vizit STAI1 ile STAI2 arasında istatistiksel olarak anlamlı
pozitif zayıf korelasyon olduğu gösterildi. STAI1 preoperatif ve STAI1 postoperatif
6. saat ile postoperatif VAS arasında istatistiksel olarak anlamlı pozitif zayıf
bir ilişki olduğu belirlendi (p=0,030; rho=0,280; p=0,003; rho=0,378). Operasyon
sonrası postoperatif ağrı beklentisi ortancası 6,0 (min=3,0; maks=10,0) olarak bulundu.

Sonuç: Çalışmamızda preoperatif
yüksek anksiyete skorlarının artmış postoperatif ağrı düzeyi ile ilişkili olduğu
gösterildi. Anksiyete uyarıları psikolojik sistem üzerinden ağrı benzeri etkiler
yaparak ağrıyı potansiyelize edebilir. Meme kanseri gibi anksiyetenin yüksek olduğu
özellikli hasta gruplarında, preoperatif anksiyete düzeyi ve diğer risk faktörleri
belirlendikten sonra postoperatif ağrı tedavisi planının yapılmasının hasta memnuniyeti
ve analjezi etkinliğini arttıracağını düşünüyoruz.

Keywords

modifiye radikal mastektomi, anksiyete, ağrı beklentisi

References

• Stewart W, Wild CP. World Cancer Report 2014 - 28 Jan 2014 B. International Agency for Research on Cancer. Lyon: IARC Publications.
• Gagnon P, Massie MJ, Holland JC. The woman with breast cancer: Psychosocial considerations. Cancer Bulletin 1993; 45: 538-42.
• Baider L, Andritsch E, Uziely B, Ever-Hadani P, Goldzweig G, Hofmann G, et al. Do different cultural settings affect the psychological distress of women with breast cancer? A randomized study. Eur J Cancer Care (Engl) 2003; 12: 263-73.
• Özkan S, Alçalar N. Psychological responses to the surgical treatment of breast cancer. J Breast Health 2009; 5: 60-3.
• Mehnert A, Koch U. Prevalence of acute and post-traumatic stress disorder and comorbid mental disorders in breast cancer patients during primary cancer care: a prospective study. Psychooncology 2007; 16: 181-8.
• Tütüncü R, Günay H. Chronic pain, psychological factors and depression. Dicle Medical J 2011; 38: 257-62.
• Özalp G, Sarıoğlu R, Tuncel G, Aslan K, Kadıoğulları N. Preoperative emotional states in patients with breast cancer and postoperative pain. Acta Anaesthesiol Scand 2003; 47: 26-9.
• Liu SS, Wu CL. The effect of analgesic technique on postoperative patient-reported outcomes including analgesia: a systematic review. Anesth Analg 2007; 105: 789-808.
• Carr E, Thomas V. Anticipating and experiencing postoperative pain: the patient’s perspective. J Clin Nurs 1997; 6: 191-201.
• Sjöling M, Nordahl G. Patient satisfaction with postoperative pain management in spite of experiences of high levels of pain. Eur Nurse 1998; 3: 264-73.
• Aouad MT, Kanazi GE, Malek K, Tamim H, Zahreddine L, Kaddoum RN. Predictors of postoperative pain and analgesic requirements following abdominal hysterectomy: an observational study. J Anesth 2016; 30: 72-9.
• Ip Vivian HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology 2009; 111: 657-77.
• Svensson I, Sjöström B, Haljamae H. Influence of expectations and actual pain experiences on satisfaction with postoperative pain management. Eur J Pain 2001; 5: 125-33.
• Yücel A. Acute pain neurophysiology and the effect of postoperative pain on systems. PCA 1998: 4-24.
• Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: Risk factors and prevention. Lancet 2006; 367: 1618-25.
• Bruce J, Thornton AJ, Powell R, Johnston M, Wells M, Heys SD, et al. Recovery Study Group. Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: A population-based cohort study. Pain 2014; 155: 232-43.
• Kaunisto MA, Jokela R, Tallgren M, Kambur O, Tikkanen E, Tasmuth T, et al. Pain in 1,000 women treated for breast cancer: a prospective study of pain sensitivity and postoperative pain. Anesthesiology 2013; 119: 1410-21.
• Roomruangwong C, Tangwongchai S, Chokchainon A. Preoperative anxiety among patients who were about to receive uterine dilatation and curettage. J Med Assoc Thai 2012; 95: 1344-51.
• Mavridou P, Dimitriou V, Manataki A, Arnaoutoglou E, Papadopoulos G. Patient’s anxiety and fear of anesthesia: effect of gender, age, education, and previous experience of anesthesia. A survey of 400 patients. J Anesth 2013; 27: 104-8.
• Bruera E, Ripamonti C. Current status of patient-controlled analgesia in cancer patients. Oncology (Williston Park) 1997; 11: 373-84.
• Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five-year observational cohort study. BMJ 2005; 330: 702-5.
• Tenenbaum G, Furst D, Weingarten G. A statistical reevaluation of the STAI anxiety questionnaire. J Clin Psychol 1985; 41: 239-44.
• Özkan S. Psychiatric and Psychosocial Aspects of Cancer. Psychiatric Medicine: Counseling Liaison Psychiatry, 1994: s. 153-74.
• Gul A, Ustundag H, Andsoy II, Kalkanli S. Anxiety and pain in surgically treated breast cancer patients. Asian Pac J Cancer Prev 2015; 16: 4261-4.
• Robleda G, Sillero-Sillero A, Puig T, Gich I, Banos JE. Influence of preoperative emotional state on postoperative pain following orthopedic and trauma surgery. Rev Lat Am Enfermagem 2014; 22: 785-91.
• Kain ZN, Sevarino FB, Rinder C, et al. Preoperative anxiolysis and postoperative recovery in women undergoing abdominal hysterectomy. Anesthesiology 2001; 94: 415-22.
• Ali A, Altun D, Oguz BH, Ilhan M, Demircan F, Koltka K. The effect of preoperative anxiety on postoperative analgesia and anesthesia recovery in patients undergoing laparascopic cholecystectomy. J Anesth 2014; 28: 222-7.
• Doering BG. Postoperative pain and psychological factors. Doctor J 2009; 94-6.
• Momeni M, Crucitti M, De Kock M. Patient-controlled analgesia in the management of postoperative pain. Drugs 2006; 66: 2321-37.