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

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

doi:10.21601/ortadogutipdergisi.460385

ORTADOĞU TIP DERGİSİ - ORTADOGU MEDICAL JOURNAL

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

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

Erbin Kandemir ¹, Tuğba Aşkın ¹, Tünay Kandemir ¹ ^* , Gonca Oğuz Tuncel ¹, Süheyla Ünver ¹

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Ortadogu Tıp Derg, Volume 11, Issue 2, pp. 136-142

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

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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

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.

Keywords: modifiye radikal mastektomi, anksiyete, ağrı beklentisi

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Citation

Kandemir E, Aşkın T, Kandemir T, Oğuz Tuncel G, Ünver S. The effect of anxiety on postoperative pain expectation and opioid consumption in modified radical mastectomy operations. Ortadogu Tıp Derg. 2019;11(2):136-42. https://doi.org/10.21601/ortadogutipdergisi.460385

Kandemir, E., Aşkın, T., Kandemir, T., Oğuz Tuncel, G., & Ünver, S. (2019). The effect of anxiety on postoperative pain expectation and opioid consumption in modified radical mastectomy operations. Ortadoğu Tıp Dergisi, 11(2), 136-142. https://doi.org/10.21601/ortadogutipdergisi.460385

Kandemir, E., Aşkın, T., Kandemir, T., Oğuz Tuncel, G., and Ünver, S. (2019). The effect of anxiety on postoperative pain expectation and opioid consumption in modified radical mastectomy operations. Ortadoğu Tıp Dergisi, 11(2), pp. 136-142. https://doi.org/10.21601/ortadogutipdergisi.460385

Kandemir E, Aşkın T, Kandemir T, Oğuz Tuncel G, Ünver S. The effect of anxiety on postoperative pain expectation and opioid consumption in modified radical mastectomy operations. Ortadogu Tıp Derg. 2019;11(2), 136-142. https://doi.org/10.21601/ortadogutipdergisi.460385

Kandemir, Erbin, Tuğba Aşkın, Tünay Kandemir, Gonca Oğuz Tuncel, and Süheyla Ünver. "The effect of anxiety on postoperative pain expectation and opioid consumption in modified radical mastectomy operations". Ortadoğu Tıp Dergisi 2019 11 no. 2 (2019): 136-142. https://doi.org/10.21601/ortadogutipdergisi.460385

Kandemir, Erbin et al. "The effect of anxiety on postoperative pain expectation and opioid consumption in modified radical mastectomy operations". Ortadoğu Tıp Dergisi, vol. 11, no. 2, 2019, pp. 136-142. https://doi.org/10.21601/ortadogutipdergisi.460385