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

Yıl 2019, , 136 - 142, 01.06.2019

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

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

Öz

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. 

Anahtar Kelimeler

Modified radical mastectomy, Anxiety, expectation of pain

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

Öz

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.

Anahtar Kelimeler

modifiye radikal mastektomi, anksiyete, ağrı beklentisi

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