Psychological characteristics and the effectiveness of patient-controlled analgesia

Abstract

We have evaluated the level of state and trait anxiety, neuroticism, extroversion and coping style as predictors of the effectiveness of patient-controlled analgesia (PCA) in 110 patients undergoing total abdominal hysterectomy. After operation patients were allocated to receive pain control with either PCA or i.m. injections (IMI). Pain was assessed using the short form McGill pain questionnaire at 6, 18 and 24 h after operation, and by recording the amount of analgesic consumed in the first 24 h after surgery. Both state anxiety and coping style were significant predictors of postoperative pain, irrespective of the method of analgesia used. Patients using PCA experienced significantly better pain control than those receiving IMI. However, it was those with high levels of state anxiety who experienced the greatest reduction in pain with PCA. In addition to achieving better pain control, patients who received PCA used significantly less analgesia and were discharged earlier than patients who received IMI.

Effects of preanesthetic administration of midazolam, clonidine, or dexmedetomidine on postoperative pain and anxiety in children

“…Moderate to intense pain and absence of nerve block are important risk factors for postoperative anxiety and have been described in numerous studies (6,32,33). The risk for high postoperative anxiety in children with moderate to intense pain is 14‐fold higher and in those without nerve block it is fivefold higher (26).…”

“…In the postoperative period, the application of the STAIC and STAI was restricted to items referring to the state of anxiety. According to previous studies (6,25,26), the mean of anxiety scale scores was used to determine the cut off point, so that individuals with scores above the average were classified as the high anxiety group and those with scores equal to or below the average as the low anxiety group.…”

“…Trait‐anxiety refers to individual differences in anxiety proneness, being a personality trait that remains relatively stable over time (5). High state‐anxiety scores indicate high levels of anxiety at the time of evaluation, while high levels of trait‐anxiety indicate an anxious personality disposition (6). Anxiety can produce aggressive reactions, increase distress and may make the control of postoperative pain difficult (1,7).…”

“…Anxiety can produce aggressive reactions, increase distress and may make the control of postoperative pain difficult (1,7). Patients with high levels of preoperative state‐anxiety are particularly vulnerable to severe pain after surgery (6,8).…”

Patient-Controlled Analgesia

“…Walder et al in a recent meta-analysis which included 2, 111 patients [5], analyzed the studies comparing PCA with conventional opioid analgesia nurse administered by intramuscular [7,8,46,47], subcutaneous [48] or intravenous [49,50] routes or by continuous perfusion [51,52].…”