Correlation between preoperative anxiety and acute postoperative pain in elderly patients submitted to transvesical prostatectomy

Bandeira, Roberto Albuquerque; Gomes, Lucy de Oliveira; Bezerra, Armando José China; Duarte, Josiane Aparecida

doi:10.5935/1806-0013.20170118

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ORIGINAL ARTICLE • Rev. dor 18 (4) • Oct-Dec 2017 • https://doi.org/10.5935/1806-0013.20170118 copy

Correlation between preoperative anxiety and acute postoperative pain in elderly patients submitted to transvesical prostatectomy

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

The objective of this study was to correlate the level of anxiety presented in the preoperative period with the intensity of pain reported by elderly in the immediate postoperative period of transvesical prostatectomy.

METHODS:

Sixty-four elderly patients submitted to transvesical prostatectomy were studied, using the following instruments: the numeric pain scale and Hamilton anxiety rating scale in the preoperative; and the short-form McGill pain questionnaire (Portuguese version adapted) in the immediate postoperative period. The elderly divided into four groups, according to the level of anxiety presented in the preoperative period: absent, mild, moderate and intense. The Spearman correlation was established between preoperative anxiety levels and postoperative pain intensity.

RESULTS:

There was a significant positive correlation between the level of preoperative anxiety and pain intensity in the immediate postoperative period. The pain curves (sensitive and affective) presented a significant increase at moments 6, 18 and 24h in all groups. These curves were significantly higher in the elderly with moderate and intense anxiety than in those without anxiety and mild anxiety. The pain peak was recorded at 18h after surgery in all groups.

CONCLUSION:

In the elderly, the level of anxiety presented in the preoperative period was positively correlated with the pain response in the immediate postoperative of transvesical prostatectomy. The use of preoperative measures that reduce anxiety can improve analgesia in the immediate postoperative period of this surgery and, therefore, reduce the amount of analgesics used in this period. There was also a need for intervention with adequate analgesia at the postoperative pain peak which occurred 18h after surgery.

Keywords:
Elderly; Postoperative pain; Preoperative anxiety; Prostatectomy; Prostate hyperplasia

	Somatic pain		Affective pain
	R	P value	R	p value
Preoperative	0.02	0.90	0.02	0.86
6h PO	0.53	0.001^* * p<0.001.	0.80	0.001^* * p<0.001.
18h PO	0.80	0.001^* * p<0.001.	0.83	0.001^* * p<0.001.
24h PO	0.76	0.001^* * p<0.001.	0.84	0.001^* * p<0.001.
30h PO	0.70	0.001^* * p<0.001.	0.87	0.001^* * p<0.001.

Measurement moments of NPS	Preoperative anxiety levels
Measurement moments of NPS	p value	p value
Preoperative	0.02	0.90
6h PO	0.75	0.001^* * p<0.001.
18h PO	0.84	0.001^* * p<0.001.
24h PO	0.77	0.001^* * p<0.001.
30h PO	0.67	0.001^* * p<0.001.

Measurements moments of PPI	Preoperative anxiety levels
Measurements moments of PPI	p value	p value
Preoperative	0.06	0.66
6h PO	0.56	0.001^* * p<0.001.
18h PO	0.76	0.001^* * p<0.001.
24h PO	0.81	0.001^* * p<0.001.
30h PO	0.16	0.21

Measurements	Moments	Group 1 (n=7)	Group 2 (n=26)	Group 3 (n=20)	Group 4 (n=11)	F value	p value
Sensitive pain	Preoperative	0.57 ± 0.53	0.54 ± 0.51	0.60 ± 0.50	0.55 ± 0.52	13.65	0.001
	6h PO	2.00 ± 0.58^* * p<0.05, difference in relation to preoperative period;	1.92 ± 0.63^* * p<0.05, difference in relation to preoperative period;	2.80 ± 1.44^* * p<0.05, difference in relation to preoperative period;	3.27 ± 0.47^* * p<0.05, difference in relation to preoperative period;
	18h PO	2.86 ± 0.69^* * p<0.05, difference in relation to preoperative period;	2.65 ± 0.69^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h;	5.20 ± 0.95^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h;	5.64 ± 0.81^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h;
	24h PO	2.00 ± 1.15^* * p<0.05, difference in relation to preoperative period;	1.96 ± 0.96^* * p<0.05, difference in relation to preoperative period; ^∞ ∞ p<0.05, difference in relation to 18h;	3.95 ± 0.83^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h;	4.36 ± 0.50^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h;
	30h PO	1.29 ± 0.49^∞ ∞ p<0.05, difference in relation to 18h;	0.96 ± 0.77^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h; ^º º p<0.05, difference in relation to 24h; PO = postoperative; NPS = numeric pain scale; PPI = present pain index.	2.35 ± 0.49^* * p<0.05, difference in relation to preoperative period; ^∞ ∞ p<0.05, difference in relation to 18h; ^º º p<0.05, difference in relation to 24h; PO = postoperative; NPS = numeric pain scale; PPI = present pain index.	2.55 ± 0.52^* * p<0.05, difference in relation to preoperative period; ^∞ ∞ p<0.05, difference in relation to 18h; ^º º p<0.05, difference in relation to 24h; PO = postoperative; NPS = numeric pain scale; PPI = present pain index.
Affective pain	Preoperative	0.14 ± 0.38	0.15 ± 0.37	0.15 ± 0.37	0.18 ± 0.40	31.50	0.001
	6h PO	1.14 ± 0.38^* * p<0.05, difference in relation to preoperative period;	1.23 ± 0.65^* * p<0.05, difference in relation to preoperative period;	3.10 ± 0.72^* * p<0.05, difference in relation to preoperative period;	3.27 ± 0.65^* * p<0.05, difference in relation to preoperative period;
	18h PO	2.14 ± 0.90^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h;	2.38 ± 0.50^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h;	5.55 ± 1.28^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h;	5.91 ± 0.94^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h;
	24h PO	1.43 ± 0.53^* * p<0.05, difference in relation to preoperative period; ^∞ ∞ p<0.05, difference in relation to 18h;	1.65 ± 0.56^* * p<0.05, difference in relation to preoperative period; ^∞ ∞ p<0.05, difference in relation to 18h;	4.10 ± 0.97^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h;	4.45 ± 0.82^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h;
	30h PO	1.00 ± 0.00^* * p<0.05, difference in relation to preoperative period; ^∞ ∞ p<0.05, difference in relation to 18h;	1.04 ± 0.45^* * p<0.05, difference in relation to preoperative period; ^∞ ∞ p<0.05, difference in relation to 18h; ^º º p<0.05, difference in relation to 24h; PO = postoperative; NPS = numeric pain scale; PPI = present pain index.	2.55 ± 0.60^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h; ^º º p<0.05, difference in relation to 24h; PO = postoperative; NPS = numeric pain scale; PPI = present pain index.	3.18 ± 0.40^* * p<0.05, difference in relation to preoperative period; ^∞ ∞ p<0.05, difference in relation to 18h; ^º º p<0.05, difference in relation to 24h; PO = postoperative; NPS = numeric pain scale; PPI = present pain index.
NPS	Preoperative	0.57 ± 0.53	0.54 ± 0.51	0.60 ± 0.50	0.55 ± 0.52	15.56	0.001
	6h PO	2.43 ± 0.53^* * p<0.05, difference in relation to preoperative period;	2.38 ± 0.57^* * p<0.05, difference in relation to preoperative period;	3.65 ± 0.59^* * p<0.05, difference in relation to preoperative period;	4.00 ± 0.63^* * p<0.05, difference in relation to preoperative period;
	18h PO	3.43 ± 0.53^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h;	3.62 ± 0.64^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h;	5.95 ± 0.76^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h;	6.18 ± 0.60^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h;
	24h PO	2.14 ± 0.38^* * p<0.05, difference in relation to preoperative period; ^∞ ∞ p<0.05, difference in relation to 18h;	2.27 ± 0.53^* * p<0.05, difference in relation to preoperative period; ^∞ ∞ p<0.05, difference in relation to 18h;	3.70 ± 0.47^* * p<0.05, difference in relation to preoperative period; ^∞ ∞ p<0.05, difference in relation to 18h;	3.64 ± 0.50^* * p<0.05, difference in relation to preoperative period; ^∞ ∞ p<0.05, difference in relation to 18h;
	30h PO	1.29 ± 0.49^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h; ^º º p<0.05, difference in relation to 24h; PO = postoperative; NPS = numeric pain scale; PPI = present pain index.	1.38 ± 0.64^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h; ^º º p<0.05, difference in relation to 24h; PO = postoperative; NPS = numeric pain scale; PPI = present pain index.	2.40 ± 0.60^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h; ^º º p<0.05, difference in relation to 24h; PO = postoperative; NPS = numeric pain scale; PPI = present pain index.	2.55 ± 0.52^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h; ^º º p<0.05, difference in relation to 24h; PO = postoperative; NPS = numeric pain scale; PPI = present pain index.
PPI	Preoperative	0.57 ± 0.53	0.54 ± 0.51	0.70 ± 0.47	0.55 ± 0.52	9.82	0.001
	6h PO	1.57 ± 0.53^* * p<0.05, difference in relation to preoperative period;	1.50 ± 0.51^* * p<0.05, difference in relation to preoperative period;	2.20 ± 0.41^* * p<0.05, difference in relation to preoperative period;	2.27 ± 0.47^* * p<0.05, difference in relation to preoperative period;
	18h PO	2.00 ± 0.58^* * p<0.05, difference in relation to preoperative period;	2.12 ± 0.59^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h;	3.35 ± 0.49^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h;	3.45 ± 0.52^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h;
	24h PO	1.00 ± 0.00^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h;	1.15 ± 0.37^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h;	2.30 ± 0.47^* * p<0.05, difference in relation to preoperative period; ^∞ ∞ p<0.05, difference in relation to 18h;	2.27 ± 0.47^* * p<0.05, difference in relation to preoperative period; ^∞ ∞ p<0.05, difference in relation to 18h;
	30h PO	1.00 ± 0.00^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h;	0.96 ± 0.34^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h;	1.05 ± 0.22^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h; ^º º p<0.05, difference in relation to 24h; PO = postoperative; NPS = numeric pain scale; PPI = present pain index.	1.09 ± 0.30^* * p<0.05, difference in relation to preoperative period; ^† † p<0.05, difference in relation to 6h; ^∞ ∞ p<0.05, difference in relation to 18h; ^º º p<0.05, difference in relation to 24h; PO = postoperative; NPS = numeric pain scale; PPI = present pain index.

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[1] Correspondence to: SHIS QL 18. Conj. 07 Casa 10, 71650-075 Brasília, DF, Brasil. E-mail: lucygomes2006@hotmail.com, bandeiraroberto1@gmail.com>