Ozturk Inal Zeynep, Gorkem Umit, Inal Hasan Ali
Department of Reproductive Endocrinology, Konya Education and Research Hospital, Konya, Turkey.
Department of Reproductive Endocrinology, Hitit University Medical Faculty, Çorum, Turkey.
J Matern Fetal Neonatal Med. 2020 Jan;33(2):191-197. doi: 10.1080/14767058.2018.1487948. Epub 2018 Jul 18.
The aim of this study was to determine the effects of preoperative anxiety on the postoperative pain and analgesic consumption in patients undergoing cesarean deliveries (CDs). This observational cohort study included 160 women, with ages ranging from 18 to 40 years old and a 37-week minimum gestation, received general (Group 1, = 80) or spinal (Group 2, = 80) anesthesia during an elective CD. The State Anxiety Inventory (SAI), Trait Anxiety Inventory (TAI), and Somatosensory Amplification Scale (SSAS) were used to measure the prenatal anxiety. The postoperative pain intensity was evaluated using the Visual Analogue Scale (VAS), and the pain and analgesic requirements were recorded at the 1st, 6th, 12th, 18th, and 24th postoperative hours. No statistically significant differences were found between the groups in the demographics, clinical characteristics, or laboratory parameters. In addition, there were no differences with regard to the mean SAI, TAI, and SSAS scores and the diclofenac and pethidine consumptions ( > .05). The 1st hour [4.15 ± 1.84 versus 3.28 ± 2.41, odds ratio (OR) = 0.832, 95% confidence interval (CI) = 0.725-0.956, = .009], 6th hour (3.85 ± 2.02 versus 3.13 ± 1.51, OR = 0.793, 95% CI = 0.668-0.942, = .008), and 12th hour (3.64 ± 2.11 versus 2.94 ± 2.03, OR = 0.851, 95% CI = 0.737-0.983, = .028) VAS scores were lower in Group 2 than in Group 1. No correlations were noted between the SAI, TAI, and SSAS scores and the VAS. While the patients with preoperative SAI scores >45 and who underwent cesarean deliveries (CDs) with general anesthesia had higher pain intensity scores in the first 12 hours than those underwent CDs with the spinal anesthesia, no difference was observed between the groups in terms of the postoperative analgesic requirements. Evaluating the patient's anxiety state and psychiatric evaluation may be useful for decreasing the postoperative pain intensity. Further studies are needed to corroborate our findings.
本研究的目的是确定剖宫产患者术前焦虑对术后疼痛及镇痛药物用量的影响。这项观察性队列研究纳入了160名年龄在18至40岁之间、孕周至少为37周的女性,她们在择期剖宫产手术中接受了全身麻醉(第1组,n = 80)或脊髓麻醉(第2组,n = 80)。使用状态焦虑量表(SAI)、特质焦虑量表(TAI)和躯体感觉放大量表(SSAS)来测量产前焦虑。采用视觉模拟量表(VAS)评估术后疼痛强度,并记录术后第1、6、12、18和24小时的疼痛及镇痛需求。两组在人口统计学、临床特征或实验室参数方面未发现统计学上的显著差异。此外,两组在SAI、TAI和SSAS的平均得分以及双氯芬酸和哌替啶的用量方面也没有差异(P > 0.05)。第2组术后第1小时[4.15±1.84 vs 3.28±2.41,比值比(OR)= 0.832,95%置信区间(CI)= 0.725 - 0.956,P = 0.009]、第6小时(3.85±2.02 vs 3.13±1.51,OR = 0.793,95% CI = 0.668 - 0.942,P = 0.008)和第12小时(3.64±2.11 vs 2.94±2.03,OR = 0.851,95% CI = 0.737 - 0.983,P = 0.028)的VAS评分低于第1组。SAI、TAI和SSAS评分与VAS之间未发现相关性。虽然术前SAI评分>45且接受全身麻醉的剖宫产患者在术后前12小时的疼痛强度评分高于接受脊髓麻醉的患者,但两组在术后镇痛需求方面未观察到差异。评估患者的焦虑状态和进行精神评估可能有助于降低术后疼痛强度。需要进一步的研究来证实我们的发现。