The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management

doi:10.1016/S0738-3991(02)00191-X

Patient Education and Counseling

Volume 51, Issue 2, October 2003, Pages 169-176

https://doi.org/10.1016/S0738-3991(02)00191-X Get rights and content

Abstract

The primary objective of this study was to test whether specific information given prior to surgery can help patients obtain better pain relief after total knee arthroplasty (TKA). Secondary objectives were to study the impact of preoperative information on state and trait anxiety, satisfaction with pain management and satisfaction with nursing care. The study was an intervention study with two groups of equal size (n=30). The intervention group was given specific information while the control group received routine information. Pain assessments were made preoperatively and every 3 h for the first three postoperative days, using the visual analogue scale (VAS). The results of this study suggest that information does influence the experience of pain after surgery and related psychological factors. The postoperative pain declined more rapidly for patients in the treatment group, the degree of preoperative state anxiety was lower and they were more satisfied with the postoperative pain management.

Introduction

Postoperative pain as a phenomenon has been studied in numerous ways. As pain is a multidimensional experience, it requires a multidimensional approach in treatment [1], as well as in behavioural preparation for the individual [2], using preoperative information, for example. Marks and Sachar’s classical article [3] spotlighted the problem of the inadequate treatment of postoperative pain. It has since been repeatedly confirmed that 30–80% of patients undergoing surgery suffer from inadequately treated pain [4], [5], [6], [7], [8], [9], [10].

In the literature, there are contradictory findings about the influence of preoperative information on postoperative pain. An often-cited study from 1964 [11] reported that the group receiving information about pain and postoperative recovery experienced less pain, required fewer analgesics for pain and had a shorter hospital stay than the control group. Other reports indicate that information can sensitise the patient to experience more pain [12], [13]. In a study, Manyande et al. [14] used a method of guided imagery, designed to increase patients’ feelings of being able to cope with the stress caused by surgery; it helped patients to be in control of the situation leading to less postoperative pain. Patients in the treatment group required fewer analgesics and their period of hospitalisation was shorter. The authors argue that a moderate level of preoperative “worry” can help patients to prepare for surgery and reduce its stressfulness. This argument is supported in another study [15].

The self-care deficit theory of nursing views self-care as the care people require every day. The theory states that people have a capability for self-care. Sometimes, health-related deficiencies may interfere, in which case nursing interventions may be needed to support or promote the individual person’s capabilities. Orem and co-worker’s theory provides guidelines for designing nursing care interventions such as information prior to surgery, which is a part of supportive-educative nursing systems [16].

Preoperative anxiety has been seen to influence patients to experience more pain after surgery [17], [18]. Furthermore, preoperative information is considered to be an important tool in helping patients to reduce the anxiety associated with surgery [13], [17], [18]. Patients frequently request information about anxiety-related factors such as postoperative pain and postoperative symptoms [19].

Ley [20], [21] has described the fact that patients frequently fail to understand and remember information they have been given. He argues that these aspects have an effect on patients’ satisfaction with treatment and care. Studies have also produced results which indicate that patients’ experienced level of pain does not play a crucial part in determining the levels of satisfaction with either pain treatment or nursing care [10], [22], [23]. Pain appears not to be an important factor in relation to satisfaction issues related to postoperative pain management. Many studies have shown the need for more research on the influence of preoperative information on the experience of postoperative pain [23], [24], [25].

It is shown that information given in a way that encourages patients to verbalise their pain to the staff at an early stage can cause them to take a more active part in the postoperative treatment regimen. One aim of the present study, was to enable the individual patient to take control of the situation and be able to prevent peaks of pain, i.e. to support the patients’ interactive coping strategies [26], [27].

Secondary objectives were to study the impact of preoperative information on state and trait anxiety, satisfaction with pain management and satisfaction with nursing care.

Section snippets

Method

The study followed a prospective experimental design with two parallel groups of equal size (n=30), a treatment group and a control group, in all n=60. The intervention consisted of specific information given to the treatment group. The control group received routine information. The ethics committee at Umeå University approved the study.

Basic analgesic treatment regimen

In order to prevent and treat postoperative pain, 52 patients (87%) received continuous EDA with a local anaesthetic (bupivacaine or ropivacaine). On average, EDA was used for 44.3 h (±S.D. 15.5) postoperatively (i.e. discontinued on the morning of day 2 after surgery), in terms of the aspects of EDA treatment, there were no differences between the two groups.

Three patients (two in the treatment group and one in the control group) received PCA, delivering 1 mg of cetobemidone “on demand” with a

Discussion and conclusions

As can be seen, the treatment group and the control group were equal in terms of demographic baseline characteristics (gender, age), as well as the planned pre- and postoperative anaesthetic/analgesic treatment regimen (EDA, PCA).

In this study, we are unable to demonstrate any differences between the groups regarding the actual VAS values. We are, however, convinced that the specific information did influence the experience of postoperative pain in the treatment group. Several findings support

Acknowledgements

The study was supported by grants from the Mid-Sweden Research and Development Centre at the County Council of Västernorrland, Emil Andersson’s Foundation for Medical Research, Mid Sweden University and the Swedish Society of Nursing. We are also deeply indebted to Professor Sheila Harrisson at The Queen’s University of Belfast, Northern Ireland and Hans Malker at the Mid-Sweden Research and Development Centre for reading and giving valuable criticism on the manuscript.

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The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management

Abstract

Introduction

Section snippets

Method

Basic analgesic treatment regimen

Discussion and conclusions

Acknowledgements

J. Pain Sympt. Manage.

J. Exp. Soc. Psychol.

Pain

Int. J. Nurs. Stud.

Patient Educ. Couns.

Pain

Pain

J. Pain Sympt. Manage.

J. Pain Sympt. Manage.

Reg. Anesth. Pain Med.

Behavioral preparation for surgery: benefit or harm?

J. Behav. Med.

Undertreatment of medical inpatients with narcotic analgesics

Ann. Internal. Med.

Anticipating and experiencing postoperative pain: the patients’ perspective

J. Clin. Nurs.

Optimising opioid treatment of postoperative pain

J. Pain Sympt. Manage.

Patient satisfaction with postoperative pain management in spite of experiences of high levels of pain

Eur. Nurse