Abstract
Aim: This study aimed to determine preoperative anxiety and pain levels in patients who underwent craniotomy and investigate the effects on the development of postoperative acute-chronic pain.
Materials and Methods: In this prospective, observational study, STAI-I (State-Trait Anxiety Inventory) and STAI-II were used to measure preoperative anxiety levels in a total of 104 patients who underwent craniotomy, and a visual analog score (VAS) was used to determine pain. Demographic data of the patients, ASA (American Society of Anesthesiologists) scores, comorbidities, preoperative and postoperative VAS scores, cause of preoperative anxiety, type, and duration of operation were recorded.
Results: The mean values of STAI tests showed that 31.3% of our patients had mild preoperative anxiety, 58.7% had moderate and 10% had severe preoperative anxiety. In the STAI tests we performed before the operation, the mean values were 44 ± 11.2 for STAI-I and 44.5 ± 9.4 for STAI-II. The causes of preoperative anxiety in patients were determined as surgical operation (35.6%), anesthesia applications (17.3%), insufficient information (11.5%), and the possibility of postoperative pain (3.8%). It was observed that 60.6% of our patients had pain in the preoperative period, 51.9% of patients had acute pain in postoperative the 0th minute, 69.2% in 30th minute, 54.8% in 1st hour, 44.2% in 2nd hour, 34.6% in 24th hour, 22.1% in 48th hour, and 51% of patients had chronic pain in postoperative 6th month. We found a significant relationship between STAI-I and VAS scores at the 48th hour and, between STAI-II and VAS scores at the 2nd, 24th hour, and 6th month (p<0.05).
Conclusion: It was observed that craniotomy patients mostly had moderate anxiety and moderate to severe pain before the operation, and moderate-severe acute and chronic pain developed after the operation. A significant correlation was found between preoperative anxiety and postoperative pain.
Keywords
Anxiety postoperative pain visual analog scale Anksiyete postoperatif ağrı vizüel analog skalası
References
- Gottschalk A, Berkow LC, Stevens RD, et al. Prospective evaluation of pain and analgesic use following major elective intracranial surgery. J Neurosurg 2007; 106: 210-16. PMID: 17410701 DOI: 10.3171/jns.2007.106.2.210
- Chowdhury T, Garg R, Sheshadri V, et al. Perioperative factors contributing the post-craniotomy pain: A Synthesis of Concepts. Frontiers in Medicine 2017, 4: 23. PMID: 28299313 PMCID: PMC5331036 DOI: 10.3389/fmed.2017.00023
- Batoz H, Verdonck O, Pellerin C, et al. The analgesic properties of scalp infiltrations with ropivacaine after intracranial tumoral resection. Anesth Analg 2009; 109: 240-44. PMID: 19535716 DOI: 10.1213/ane.0b013e3181a4928d
- Munafo MR, Stevenson J. Anxiety and surgical recovery. Reinterpreting the literature. J Psychosom Res 2001; 51: 589-96. PMID: 11595247 DOI: 10.1016/s0022-3999(01)00258-6
- Granot M, Ferber SG. The roles of pain catastrophizing and anxiety in the prediction of postoperative pain intensity. Clin J Pain 2005; 21:439-45. PMID: 16093750 DOI: 10.1097/01.ajp.0000135236.12705.2d
- Kehlet H, Jensen ST, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. The Lancet 2006; 357 (9522):1618-25. PMID: 16698416 DOI: 10.1016/S0140-6736 (06) 68700-X
- Spielberger CD, Auerbach SM, Wadsworth AP. Emotional reactions to surgery. J Consult Clin Psychol 1973; 40: 33-8. PMID: 4688678 DOI: 10.1037/h0033982
- Rocha-Filho PA, Post-Craniotomy Headache: A clinical view with a focus on the persistent form. Headache. 2015. American Headache Society. May 2015:733-8. PMID: 25903913 DOI: 10.1111/head.12563
- Klopfenstein EC, Forster A, Gessel EV. Anaesthetic assessment in an outpatient consultation clinic reduces preoperative anxiety. Can J Anaesth.2000:47; 6,511-515 DOI: 10.1007/BF03018941.
- Aykent R, Kocamanoğlu İS, Üstün E, Tür A, Şahinoğlu H. Preoperatif anksiyete nedenleri ve değerlendirilmesi: APAİS ve STAI skorlarının karşılaştırılması. Türkiye Klinikleri J Anest.Rean.2007:5; 7-13.
- Perks A, Chakravarti S, Manninen P. Preoperative anxiety in neurosurgical patients. J Neurosurg Anesthesiol 2009; 21: 127-30. PMID: 19295391 DOI: 10.1097/ANA.0b013e31819a6ca3
- Moerman N, van Dam FSAM, Muller MJ, Oosting H. Amsterdam Preoperative Anxiety and Information Scale Study. Anesth Analg 1996; 82: 445-51. PMID: 8623940 DOI: 10.1097/00000539-199603000-00002
- Öner N. and A. Le Compte. (Süreksiz) Durumluluk - Sürekli Kaygı Envanteri El Kitabı: Boğaziçi Üniversitesi Yayınevi, 2.baskı, İstanbul, 1998
- Türkoğlu M. Ağrının tanımlanması ve ölçümü. Ağrı ve Tedavisi. Editör: Yegül İ. 1993; 19-28.
- Wagner A, Shiban Y, Lange N, Joerger A, Hoffmann U, Meyer B, Shiban E. The relevant psychological burden of having a benign brain tumor: a prospective study of patients undergoing surgical treatment of cranial meningiomas. J Neurosurg. 2019 Jan 11; 131(6):1840-7. DOI: 10.3171/2018.8.JNS181343.
- Inal F, Camgoz Y, Daskaya H, Kocoglu H. The effect of preoperative anxiety and pain sensitivity on preoperative hemodynamics, propofol consumption, and postoperative recovery and pain in endoscopic ultrasonography. Pain Ther (2021) 10:1283–93 https://doi.org/10.1007/s40122-021-00292-7.
- Brandsborg B, Nikolajsen L, Hansen CT, Kehlet H, Jensen TS. Risk factors for chronic pain after hysterectomy: a nationwide questionnaire and database study. Anesthesiology 2007; 106:1003-12. PMID: 17457133 DOI: 10.1097/01.anes.0000265161.39932.e8
- Maranets I, Kain ZN. Preoperative anxiety and intraoperative anesthetic requirements. Anesth Analg 1999; 89: 1346-51. PMID: 10589606 DOI: 10.1097/00000539-199912000-00003
- Goebel S, Kaup L, Mehdorn HM. Measuring preoperative anxiety in patients with intracranial tumors: The Amsterdam Preoperative Anxiety and Information Scale - J Neurosurg Anesthesiol _ Volume 23, Number 4, October 2011. PMID: 21691216 DOI: 10.1097/ANA.0b013e318222b787
- Tadesse M, Ahmed S, Regassa T, et al. Effect of preoperative anxiety on postoperative pain on patients undergoing elective surgery: Prospective cohort study. Ann Med Surg (Lond). 2021 Dec 22; 73:103190. DOI: 10.1016/j.amsu.2021.103190. eCollection 2022 Jan
- Özalp G, Sarıoğlu R, Tuncel G, Aslan K, Kadıoğulları N. Preoperative emotional states in patients with breast cancer and postoperative pain. Acta Anaesthesiol Scand 2003; 47:26-9. PMID: 12492793 DOI: 10.1034/j.1399-6576.2003.470105.x
- De Benedittis G, Lorenzetti A, Migliore M, Spagnoli D, Tiberio F, Villani RM. Postoperative pain in neurosurgery: a pilot study in brain surgery. Neurosurgery 1996; 38 :466-9. PMID: 8837797 DOI: 10.1097/00006123-199603000-00008 Suksompong S, Chaikittisilpa N, Rutchadawong T, Chankaew E, von Bormann B. Pain after major craniotomy in a university hospital: A prospective cohort study. J Med Assoc Thai. 2016 May; 99(5):539-48. PMID: 27501609
- Rocha-Filho PA, Gherpelli JL, de Siqueira JT, Rabello GD. Postcraniotomy headache: characteristics, behavior, and effect on the quality of life in patients operated for treatment of supratentorial intracranial aneurysms. Cephalalgia 2008; 28:41-8. PMID: 17986272 DOI: 10.1111/j.1468-2982.2007.01465.x
- Kaur A, Selwa L, Fromes G, Ross DA. Persistent headache after supratentorial craniotomy. Neurosurgery 2000; 47:633-6. PMID: 10981750 DOI: 10.1097/00006123-200009000-00020
- Kvaal K, Ulstein I, Nordhus IH, Engedal K. The Spielberger State-Trait Anxiety Inventory (STAI): the state scale in detecting mental disorders in geriatric patients. Int J Geriatr Psychiatry 2005; 20:629-34. PMID: 16021666 DOI: 10.1002/gps.1330
- Shipton E. Post-surgical pain. ANZ J Surg 2008; 78:548. PMID: 18593408 DOI: 10.1111/j.1445-2197.2008.04569.x
- Harner SG, Beatty CW, Ebersold MJ. Headache after acoustic neuroma excision. Am J Otol 1993; 14: 552-5. PMID: 8296857
- Nemergut EC, Durieux ME, Missaghi NB, Himmelseher S. Pain management after craniotomy. Best Pract Res Clin Anaesthesiol 2007; 21 (4): 557-73. PMID: 18286837 DOI: 10.1016/j.bpa.2007.06.005
- Caumo W, Schmidt AP, Schneider CN, et al. Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery. Acta Anesthesiol Scand 2002; 46:1265-71. PMID: 12421200 DOI: 10.1034/j.1399-6576.2002.461015.x
- Gottschalk A, Berkow LC, Stevens RD, et al. Prospective evaluation of pain and analgesic use following major elective intracranial surgery. J Neurosurg 2007; 106: 210-6. PMID: 17410701 DOI: 10.3171/jns.2007.106.2.210
- Greenberg S, Murphy GS, Avram MJ, et al. Postoperative intravenous acetaminophen for craniotomy patients: A randomized controlled trial. World Neurosurg. 2018 Jan; 109:554-62. DOI: 10.1016/j.wneu.2017.10.021. Epub 2017 Oct 16.
- Walavan S, Michael J, Julie M, et al. Intravenous acetaminophen for postoperative supratentorial craniotomy pain: a prospective, randomized, double-blinded, placebo-controlled trial. J Neurosurg April 20, 2018:1–7. doi:10.3171/2017.10.jns171464
- Yun Y, Wang J, Tang R, et al. Effects of an intraoperative dexmedetomidine bolus on the postoperative blood pressure and pain subsequent to craniotomy for supratentorial tumors. J Neurosurg Anaesthesiol. 2017;29(3):211–8. PMID: 26859547 DOI: 10.1097/ANA.0000000000000283
- Shimony N, Amit U, Minz B, et al. Perioperative pregabalin for reducing pain, analgesic consumption, and anxiety and enhancing sleep quality in elective neurosurgical patients: a prospective, randomized, double-blind, and controlled clinical study. J Neurosurg. 2016;125: 1513–22. PMID: 26871201 DOI: 10.3171/2015.10.JNS151516.
Abstract
Amaç: Bu çalışmada kraniyotomi uygulanan hastalardaki preoperatif anksiyete ve ağrı düzeylerinin belirlenmesi ve postoperatif akut veya kronik ağrı gelişimi üzerine olan etkilerinin araştırılması amaçlanmıştır.
Gereç ve Yöntem: Prospektif, gözlemsel yapılan çalışmamızda, kraniyotomi uygulanan toplam 104 hastanın operasyon öncesi anksiyete düzeylerini ölçmek için STAI-I (State Trait Anxiety Inventory) ve STAI-II, ağrı düzeylerini belirlemek için ise VAS (Vizüel Analog Skoru) kullanıldı. Hastaların demografik verileri, ASA (American Society of Anesthesiologists) skorları, eşlik eden hastalıkları, preoperatif ağrı varlığı ve preoperatif- postoperatif VAS skorları, preoperatif anksiyete kaynağı, operasyon çeşidi ve süresi kaydedildi.
Bulgular: STAI testleri ortalama değerleri hastalarımızın %31,3' ünde hafif, %58,7' sinde orta ve %10' unda şiddetli düzeyde preoperatif anksiyete olduğunu gösterdi. Operasyon öncesi uygulanan STAI testlerinde ortalama değerler, STAI-I için 44 ± 11,2 ve STAI-II için 44,5 ± 9,4 olarak bulundu. Preoperatif anksiyete nedenleri cerrahi operasyon (%35,6), anestezi uygulamaları (%17,3), eksik bilgilendirilme (%11,5) ve ameliyat sonrası ağrı olasılığı (%3,8) olarak belirlendi. Hastaların %60,6’sında preoperatif dönemde, %51,9 ’unda postoperatif 0.dakikada, %69,2 ’sinde 30. dakikada, %54,1’inde 1.saatte, %44,2 ’sinde 2. saatte, %34,6’sında 24.saatte, %22,1’inde 48.saatte akut ağrı ve %51‘inde ise postoperatif 6. ayda kronik ağrı geliştiği görüldü. STAI-I skorları ile 48. saat VAS, STAI-II skorları ile 2. saat, 24. saat ve 6. ay VAS skorları arasında istatistiksel olarak anlamlı ilişki bulundu (p<0,05).
Sonuç: Kraniyotomi hastalarının ameliyat öncesi çoğunlukla orta düzeyde anksiyeteye ve orta -ciddi düzeyde ağrıya sahip oldukları, operasyon sonrası orta-ciddi düzeyde akut ve kronik ağrı geliştiği görüldü. Operasyon öncesi anksiyete ile ameliyat sonrası ağrı arasında anlamlı bir ilişki olduğu bulundu.
References
- Gottschalk A, Berkow LC, Stevens RD, et al. Prospective evaluation of pain and analgesic use following major elective intracranial surgery. J Neurosurg 2007; 106: 210-16. PMID: 17410701 DOI: 10.3171/jns.2007.106.2.210
- Chowdhury T, Garg R, Sheshadri V, et al. Perioperative factors contributing the post-craniotomy pain: A Synthesis of Concepts. Frontiers in Medicine 2017, 4: 23. PMID: 28299313 PMCID: PMC5331036 DOI: 10.3389/fmed.2017.00023
- Batoz H, Verdonck O, Pellerin C, et al. The analgesic properties of scalp infiltrations with ropivacaine after intracranial tumoral resection. Anesth Analg 2009; 109: 240-44. PMID: 19535716 DOI: 10.1213/ane.0b013e3181a4928d
- Munafo MR, Stevenson J. Anxiety and surgical recovery. Reinterpreting the literature. J Psychosom Res 2001; 51: 589-96. PMID: 11595247 DOI: 10.1016/s0022-3999(01)00258-6
- Granot M, Ferber SG. The roles of pain catastrophizing and anxiety in the prediction of postoperative pain intensity. Clin J Pain 2005; 21:439-45. PMID: 16093750 DOI: 10.1097/01.ajp.0000135236.12705.2d
- Kehlet H, Jensen ST, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. The Lancet 2006; 357 (9522):1618-25. PMID: 16698416 DOI: 10.1016/S0140-6736 (06) 68700-X
- Spielberger CD, Auerbach SM, Wadsworth AP. Emotional reactions to surgery. J Consult Clin Psychol 1973; 40: 33-8. PMID: 4688678 DOI: 10.1037/h0033982
- Rocha-Filho PA, Post-Craniotomy Headache: A clinical view with a focus on the persistent form. Headache. 2015. American Headache Society. May 2015:733-8. PMID: 25903913 DOI: 10.1111/head.12563
- Klopfenstein EC, Forster A, Gessel EV. Anaesthetic assessment in an outpatient consultation clinic reduces preoperative anxiety. Can J Anaesth.2000:47; 6,511-515 DOI: 10.1007/BF03018941.
- Aykent R, Kocamanoğlu İS, Üstün E, Tür A, Şahinoğlu H. Preoperatif anksiyete nedenleri ve değerlendirilmesi: APAİS ve STAI skorlarının karşılaştırılması. Türkiye Klinikleri J Anest.Rean.2007:5; 7-13.
- Perks A, Chakravarti S, Manninen P. Preoperative anxiety in neurosurgical patients. J Neurosurg Anesthesiol 2009; 21: 127-30. PMID: 19295391 DOI: 10.1097/ANA.0b013e31819a6ca3
- Moerman N, van Dam FSAM, Muller MJ, Oosting H. Amsterdam Preoperative Anxiety and Information Scale Study. Anesth Analg 1996; 82: 445-51. PMID: 8623940 DOI: 10.1097/00000539-199603000-00002
- Öner N. and A. Le Compte. (Süreksiz) Durumluluk - Sürekli Kaygı Envanteri El Kitabı: Boğaziçi Üniversitesi Yayınevi, 2.baskı, İstanbul, 1998
- Türkoğlu M. Ağrının tanımlanması ve ölçümü. Ağrı ve Tedavisi. Editör: Yegül İ. 1993; 19-28.
- Wagner A, Shiban Y, Lange N, Joerger A, Hoffmann U, Meyer B, Shiban E. The relevant psychological burden of having a benign brain tumor: a prospective study of patients undergoing surgical treatment of cranial meningiomas. J Neurosurg. 2019 Jan 11; 131(6):1840-7. DOI: 10.3171/2018.8.JNS181343.
- Inal F, Camgoz Y, Daskaya H, Kocoglu H. The effect of preoperative anxiety and pain sensitivity on preoperative hemodynamics, propofol consumption, and postoperative recovery and pain in endoscopic ultrasonography. Pain Ther (2021) 10:1283–93 https://doi.org/10.1007/s40122-021-00292-7.
- Brandsborg B, Nikolajsen L, Hansen CT, Kehlet H, Jensen TS. Risk factors for chronic pain after hysterectomy: a nationwide questionnaire and database study. Anesthesiology 2007; 106:1003-12. PMID: 17457133 DOI: 10.1097/01.anes.0000265161.39932.e8
- Maranets I, Kain ZN. Preoperative anxiety and intraoperative anesthetic requirements. Anesth Analg 1999; 89: 1346-51. PMID: 10589606 DOI: 10.1097/00000539-199912000-00003
- Goebel S, Kaup L, Mehdorn HM. Measuring preoperative anxiety in patients with intracranial tumors: The Amsterdam Preoperative Anxiety and Information Scale - J Neurosurg Anesthesiol _ Volume 23, Number 4, October 2011. PMID: 21691216 DOI: 10.1097/ANA.0b013e318222b787
- Tadesse M, Ahmed S, Regassa T, et al. Effect of preoperative anxiety on postoperative pain on patients undergoing elective surgery: Prospective cohort study. Ann Med Surg (Lond). 2021 Dec 22; 73:103190. DOI: 10.1016/j.amsu.2021.103190. eCollection 2022 Jan
- Özalp G, Sarıoğlu R, Tuncel G, Aslan K, Kadıoğulları N. Preoperative emotional states in patients with breast cancer and postoperative pain. Acta Anaesthesiol Scand 2003; 47:26-9. PMID: 12492793 DOI: 10.1034/j.1399-6576.2003.470105.x
- De Benedittis G, Lorenzetti A, Migliore M, Spagnoli D, Tiberio F, Villani RM. Postoperative pain in neurosurgery: a pilot study in brain surgery. Neurosurgery 1996; 38 :466-9. PMID: 8837797 DOI: 10.1097/00006123-199603000-00008 Suksompong S, Chaikittisilpa N, Rutchadawong T, Chankaew E, von Bormann B. Pain after major craniotomy in a university hospital: A prospective cohort study. J Med Assoc Thai. 2016 May; 99(5):539-48. PMID: 27501609
- Rocha-Filho PA, Gherpelli JL, de Siqueira JT, Rabello GD. Postcraniotomy headache: characteristics, behavior, and effect on the quality of life in patients operated for treatment of supratentorial intracranial aneurysms. Cephalalgia 2008; 28:41-8. PMID: 17986272 DOI: 10.1111/j.1468-2982.2007.01465.x
- Kaur A, Selwa L, Fromes G, Ross DA. Persistent headache after supratentorial craniotomy. Neurosurgery 2000; 47:633-6. PMID: 10981750 DOI: 10.1097/00006123-200009000-00020
- Kvaal K, Ulstein I, Nordhus IH, Engedal K. The Spielberger State-Trait Anxiety Inventory (STAI): the state scale in detecting mental disorders in geriatric patients. Int J Geriatr Psychiatry 2005; 20:629-34. PMID: 16021666 DOI: 10.1002/gps.1330
- Shipton E. Post-surgical pain. ANZ J Surg 2008; 78:548. PMID: 18593408 DOI: 10.1111/j.1445-2197.2008.04569.x
- Harner SG, Beatty CW, Ebersold MJ. Headache after acoustic neuroma excision. Am J Otol 1993; 14: 552-5. PMID: 8296857
- Nemergut EC, Durieux ME, Missaghi NB, Himmelseher S. Pain management after craniotomy. Best Pract Res Clin Anaesthesiol 2007; 21 (4): 557-73. PMID: 18286837 DOI: 10.1016/j.bpa.2007.06.005
- Caumo W, Schmidt AP, Schneider CN, et al. Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery. Acta Anesthesiol Scand 2002; 46:1265-71. PMID: 12421200 DOI: 10.1034/j.1399-6576.2002.461015.x
- Gottschalk A, Berkow LC, Stevens RD, et al. Prospective evaluation of pain and analgesic use following major elective intracranial surgery. J Neurosurg 2007; 106: 210-6. PMID: 17410701 DOI: 10.3171/jns.2007.106.2.210
- Greenberg S, Murphy GS, Avram MJ, et al. Postoperative intravenous acetaminophen for craniotomy patients: A randomized controlled trial. World Neurosurg. 2018 Jan; 109:554-62. DOI: 10.1016/j.wneu.2017.10.021. Epub 2017 Oct 16.
- Walavan S, Michael J, Julie M, et al. Intravenous acetaminophen for postoperative supratentorial craniotomy pain: a prospective, randomized, double-blinded, placebo-controlled trial. J Neurosurg April 20, 2018:1–7. doi:10.3171/2017.10.jns171464
- Yun Y, Wang J, Tang R, et al. Effects of an intraoperative dexmedetomidine bolus on the postoperative blood pressure and pain subsequent to craniotomy for supratentorial tumors. J Neurosurg Anaesthesiol. 2017;29(3):211–8. PMID: 26859547 DOI: 10.1097/ANA.0000000000000283
- Shimony N, Amit U, Minz B, et al. Perioperative pregabalin for reducing pain, analgesic consumption, and anxiety and enhancing sleep quality in elective neurosurgical patients: a prospective, randomized, double-blind, and controlled clinical study. J Neurosurg. 2016;125: 1513–22. PMID: 26871201 DOI: 10.3171/2015.10.JNS151516.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | December 12, 2022 |
| Submission Date | February 23, 2022 |
| Published in Issue | Year 2022Volume: 61 Issue: 4 |
