Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Reg Anesth Pain Med. 2022 Oct;47(10):637-642. doi: 10.1136/rapm-2022-103742. Epub 2022 Aug 16.
Although perioperative anxiety is common, its trajectory and influence on postoperative pain and opioid use are not well understood. We sought to examine the association and trajectory of perioperative anxiety, pain and opioid use following common surgical procedures.
We conducted a prospective cohort study of 1771 patients undergoing elective surgical procedures. Self-reported opioid use, pain (Brief Pain Inventory) and anxiety (Patient-Reported Outcome Measurement Information System (PROMIS) Anxiety) were recorded on the day of surgery and at 1 month, 3 months and 6 months postsurgery. Clinically significant anxiety was defined as a PROMIS Anxiety T-score ≥55. We examined postoperative opioid use in the context of surgical site pain and anxiety using mixed-effects regression models adjusted for covariates, and examined anxiety as a mediator between pain and opioid use.
In this cohort, 65% of participants completed all follow-ups and 30% reported clinically significant anxiety at baseline. Anxiety and surgical site pain were highest on the day of surgery (anxiety: mean=49.3, SD=9.0; pain: mean=4.3, SD=3.3) and declined in the follow-up period. Those with anxiety reported higher opioid use (OR=1.40; 95% CI 1.0, 1.9) and 1.14-point increase in patient-reported surgical pain (95% CI 1.0, 1.3) compared with those without anxiety. Anxiety had no significant mediation effect on the relationship of pain and opioid use.
Anxiety is an independent risk factor for increased pain and opioid use after surgery. Future studies examining targeted behavioral therapies to reduce anxiety during the perioperative period may positively impact postoperative pain and opioid use.
尽管围手术期焦虑很常见，但它对术后疼痛和阿片类药物使用的轨迹和影响尚不清楚。我们试图研究常见手术程序后围手术期焦虑、疼痛和阿片类药物使用之间的关联和轨迹。
我们对 1771 名接受择期手术的患者进行了前瞻性队列研究。在手术当天以及术后 1 个月、3 个月和 6 个月，记录了自我报告的阿片类药物使用、疼痛（简明疼痛量表）和焦虑（患者报告的结果测量信息系统（PROMIS）焦虑）。临床显著焦虑定义为 PROMIS 焦虑 T 评分≥55。我们使用混合效应回归模型，根据协变量调整了手术部位疼痛和焦虑对术后阿片类药物使用的影响，并研究了焦虑作为疼痛和阿片类药物使用之间的中介因素。
在该队列中，65%的参与者完成了所有随访，30%的参与者在基线时报告有临床显著的焦虑。焦虑和手术部位疼痛在手术当天最高（焦虑：平均=49.3，标准差=9.0；疼痛：平均=4.3，标准差=3.3），并在随访期间下降。与无焦虑者相比，有焦虑者报告的阿片类药物使用量更高（OR=1.40；95%CI 1.0，1.9）和患者报告的手术疼痛增加 1.14 分（95%CI 1.0，1.3）。焦虑对疼痛和阿片类药物使用之间的关系没有显著的中介作用。
焦虑是术后疼痛和阿片类药物使用增加的独立危险因素。未来研究检查围手术期靶向行为疗法以减少焦虑，可能会对术后疼痛和阿片类药物使用产生积极影响。
