Relation of pain threshold and effect of postoperative analgesia with preoperative anxiety in patients with hysteromyoma / 中国心理卫生杂志

ABSTRACT

Objective: To evaluate the relation between preoperative anxiety and pain threshold in patients with hysteromyoma, and to investigate the effect of anxiety on postoperative analgesia. Methods: Fifty patients with hysteromyoma were included and evaluated the anxiety level with the Self-Rating Anxiety Scale (SAS) 1 day before hysterectomy. Threshold of heat pain and cold pain of all patients were also assessed by quantitative sensory testing (QST) at the same time. All patients received hysterectomy under the combined spinal epidural anesthesia,and 2 mg morphine were injected to their epidural spaces 10 min before the end of surgery. Visual analgesia scores (VAS, 0～10) were performed to evaluate the level of pain at 0 h, 2 h, 6 h and 12 h after the operation. The time of first ambulation after operation were also recorded to help assess the effect of postoperative analgesia. Results:The average SAS scores of all these 50 patients was (48.7±10.3) . And 13 cases (26%) were with mild anxiety (SAS=50-59), whereas 5 cases (10%) were with moderate or severe anxiety (SAS≥60) . The threshold of heat pain and cold pain were (37.8±3.1)℃ and (15.8±3.6)℃.VAS at all investigated time points was 0,(1.4±1.1), (3.3±1.6) and (4.4±2.1) . There was significantly negative correlation between the SAS scores and the pain threshold of all patients with anxiety (r=-0.67, -0.56; Ps<0.001). But for these patients, the correlations between the SAS scores and VAS scores at 6h and 12h after the operation were positive (r=0.48,0.55, Ps<0.001) . Furthermore, the average time of first ambulation after operation in those anxious patients was later than that in the patients with no anxiety (SAS<50) [(46.6±7.1) h vs.(39.8±9.3) h, P <0.05].Conclusion: The higher level of preoperative anxiety in patients with hysteromyoma is correlated to higher level ofpain threshold, less effect of analgesia and longer time to recovery. It indicates that it is necessary to assess preoper-ative anxiety in patients with hysteromyoma.