Overestimating postoperative pain may cause anxiety

Overestimating the anticipated amount of pain patients experience following surgery can cause unnecessary anxiety in them, researchers have warned.

“This is especially true for patients receiving regional anaesthesia who may not fully understand the benefits of nerve blocks and other regional anaesthesia procedures aimed at preventing postoperative pain,” said Jaime L. Baratta, director of regional anaesthesia at Thomas Jefferson University Hospital in Philadelphia.

“We believe providers need to do a better job of counselling patients on realistic pain expectations.” For the study, being presented at the ANESTHESIOLOGY 2017 annual meeting, researchers included 223 patients, averaging 61 years old, who were undergoing orthopaedic, neurosurgical or general surgery procedures.
Of these, 96 received some type of regional anaesthesia (spinal, epidural or peripheral nerve block). Of the 96 patients, 80 had no general anaesthesia while 16 had general anaesthesia with a peripheral nerve block before or after surgery. The remaining 127 patients received only general anaesthesia. Patients completed a questionnaire before surgery to evaluate what level of postoperative pain they expected on a 0-10 scale.

They were asked about their level of pain in the post-anaesthesia care unit (PACU) one hour following surgery and on the first day after surgery. Patients’ average expected pain rating immediately following surgery was 4.66 compared to an actual pain rating of 2.56. The average expected pain rating on the first day after surgery was 5.45 compared to an actual pain rating of 4.30.
Patients who had regional anaesthesia had an average expected pain rating in the PACU of 4.63 compared to an actual pain rating of 0.92. The average expected pain rating for these patients on the first day after surgery was 5.47 compared to an actual pain rating of 3.45. Patients receiving regional anaesthesia before surgery may experience unnecessary anxiety and have exaggerated pain expectations simply because they do not understand regional anaesthesia’s pain relieving benefits, the researchers said.

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