Effect of preoperative anxiety on postoperative pain on patients undergoing elective surgery: Prospective cohort study

Abstract Background: Virtual reality (VR) is a promising new technology that offers opportunities to modulate patient experience and cognition. There is limited work on VR effectiveness during the preoperative period in the local setting. We investigated the feasibility and practicability of employing VR in anxiety management for patients undergoing minor gynaecological surgery, with the primary outcome being the changes in preoperative anxiety levels before and after the VR experience. Methods: A prospective cohort study was conducted in the KK Women’s and Children’s hospital between March 2019 and January 2020. Female patients undergoing gynaecological surgeries were recruited after obtaining informed consent. Patients were given a VR headset accompanied with a handphone loaded with VR experiences comprising sceneries, background meditation music and breathing exercises. The VR experience was administered for 10 mins and pre- and post-VR psychological assessments surveys were conducted. Results: Data analysis from 108 patients showed that our patient population had moderate state anxiety (39.6 (SD 11.14) and trait anxiety 40.1 (9.07) on the State-Trait Anxiety Inventory (STAI). The use of VR before surgery could reduce both Hospital Anxiety and Depression Scale (HADS) anxiety (7.2 ± 3.3 down to 4.6 ± 3.0; p<0.0001) and depression (4.7 ± 3.3 down to 2.9 ± 2.5; p<0.0001) scores. EQ-5D-3Lshowed no significant change in dimensions of ‘mobility’ and ‘self-care’ but significant changes to reported ‘usual activities’, ‘pain/discomfort’ and anxiety/ depression’ dimensions. Level 1 for ‘usual activities’ (“no problems with performing usual activities”) increased from 102 (94.4%) to 107 (99.1%) (p= 0.0253), ‘pain/discomfort’ (“I have no pain/discomfort”) increased from 72 (66.7%) to 84 (77.8%) and ‘anxiety/ depression’ (“I am not anxious/ depressed”) increased from 62 (57.4%) to 90 (83.3%) between pre- and post-VR experience. About 82% of patients rated the VR experience as ‘Good’ or ‘Excellent’.Conclusions: Our study showed significant reduction in preoperative anxiety after VR experience and has positive patient satisfaction. The use of VR may be suitable for patients with high anxiety preoperatively without the use of anxiolytics. Future work could include implementation studies upon adoption in clinical practice and the use in other surgical populations. Trial registration: Clinicaltrials.gov NCT03685422. Registered 26Sep2018 https://clinicaltrials.gov/ct2/show/NCT03685422?term=NCT03685422&draw=2&rank=1

Download Full-text

Comparison of Postoperative Pain between Patients who underwent Primary and Repeated Caesarean Section: A Prospective Cohort Study

10.21203/rs.2.169/v2 ◽

2019 ◽

Author(s):

Guangyou Duan ◽

Guiying Yang ◽

Jing Peng ◽

Zhenxin Duan ◽

Jie Li ◽

...

Keyword(s):

Cohort Study ◽

Postoperative Pain ◽

Visual Analogue Scale ◽

Cesarean Section ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Analogue Scale ◽

Visceral Pain ◽

Significant Difference ◽

Repeat Cesarean Section

Abstract Background: The presences of differences in post-operative pain are unclear between the primipara who underwent a primary cesarean section and multipara who underwent first repeat cesarean section. The study aimed to explore the possible difference in postoperative pain between primipara and multipara. Methods: A prospective cohort study was carried out, and only women who underwent cesarean deliveries under spinal anesthesia were included. Postoperative patient-controlled intravenous analgesia was performed for all subjects with 0.2 mg/kg hydromorphone and 4 mg/kg flurbiprofen, and the pump was programmed as 2.0 mL/h background infusion, and loading dose of 1 mL with a lockout period of 15 min. Postoperative incision and visceral pain intensity were evaluated using visual analogue scale, and inadequate analgesia was defined as visual analogue scale ≥40 during the postoperative 48 hours. Additionally, the patients’ pain statuses on postoperative week 1 and week 4 were also assessed during follow-up via telephone. Results: From January to May 2017, a total of 168 patients (67 primipara and 101 multipara) were included. The relative risk for multipara to experience inadequate analgesia on incision pain was 0.42 (95% CI: 0.25 to 0.74) compared to primipara. In patients under 30 years old, inadequate analgesia on visceral pain in the multipara was higher than that on the primipara (RR, 3.56 [1.05 to 12.04], P=0.025). There was no significant difference in the combined incidence of inadequate analgesia in both types of pain between the multipara and primipara (33.7%vs.40.2%, P=0.381). No difference was found in PCIA consumption between two groups. (111.1 ± 36.0mL vs. 110.9 ± 37.3mL, P=0.979) Additionally, a significantly higher incidence of pain at 4 weeks after the surgery was noted in the primipara compared to the multipara (62.2%vs.37.7%, P=0.011). Conclusions: Multipara who underwent first repeat cesarean section have lower risk to experience inadequate analgesia on incision pain during the first 48 hours after surgery compared to primipara. While multipara under 30 years may be more prone to experiencing postoperative inadequate analgesia on visceral pain.

Download Full-text

Comparison of postoperative pain between patients who underwent primary and repeated cesarean section: a prospective cohort study

BMC Anesthesiology ◽

10.1186/s12871-019-0865-9 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Guangyou Duan ◽

Guiying Yang ◽

Jing Peng ◽

Zhenxin Duan ◽

Jie Li ◽

...

Keyword(s):

Cohort Study ◽

Postoperative Pain ◽

Visual Analogue Scale ◽

Cesarean Section ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Analogue Scale ◽

Visceral Pain ◽

Significant Difference ◽

Repeat Cesarean Section

Abstract Background The differences in post-operative pain are unclear between the primiparas who underwent a primary cesarean section and multiparas who underwent their first repeat cesarean section. The study aimed to explore the possible differences in postoperative pain between primiparas and multiparas. Methods A prospective cohort study was performed only including women who underwent cesarean deliveries under spinal anesthesia. Postoperative patient-controlled intravenous analgesia (PCIA) was administered to all subjects with 0.2 mg/kg hydromorphone and 4 mg/kg flurbiprofen; the pump was programmed as 2.0 mL/h background infusion with a loading dose of 1 mL and a lockout period of 15 min. Postoperative incision and visceral pain intensity were evaluated using the visual analogue scale, and inadequate analgesia was defined as a visual analogue scale score ≥ 40 during 48 h post-operation. Additionally, the patients’ pain statuses in postoperative week 1 and week 4 were also assessed during follow-up via telephone. Results From January to May 2017, a total of 168 patients (67 primiparas and 101 multiparas) were included. The relative risk for multiparas to experience inadequate analgesia on incision pain was 0.42 (95% CI: 0.25 to 0.74) compared to primiparas. In patients aged < 30 years, inadequate analgesia on visceral pain was higher in multiparas than in primiparas (RR, 3.56 [1.05 to 12.04], P = 0.025). There was no significant difference in the combined incidence of inadequate analgesia in both types of pain between the multiparas and primiparas (33.7% vs. 40.2%, P = 0.381). No difference was found in PCIA use between the two groups (111.1 ± 36.0 mL vs. 110.9 ± 37.3 mL, P = 0.979). In addition, a significantly higher incidence of pain was noted 4 weeks post-surgery in primiparas than that in multiparas (62.2% vs. 37.7%, P = 0.011). Conclusion Multiparas who underwent their first repeat cesarean section have a lower for inadequate analgesia on incision pain during the first 48 h after surgery than primiparas. Multiparas aged under 30 years may be more prone to experiencing postoperative inadequate analgesia on visceral pain. Trail Registration ClinicalTrial.gov: NCT03009955, Date registered: December 30, 2016.

Download Full-text