Effects of patient-controlled analgesia on postoperative anxiety in elderly men.
OBJECTIVE
To determine whether the use of patient-controlled analgesia vs intramuscular injections improves postoperative psychological parameters, particularly anxiety.


METHODS
Randomized, controlled trial of patient-controlled analgesia vs as-needed intramuscular morphine with pre- and postoperative assessments of pain, mental status, narcotic use, anxiety and mood states.


METHODS
General surgical wards and surgical intensive care unit at a Veterans Administration hospital.


METHODS
Eighty-three elderly, chronically ill males undergoing major elective surgery.


METHODS
Subjects randomized to receive postoperative patient-controlled analgesia vs as-needed intramuscular morphine. Pre- and postoperative assessments of State-Trait Anxiety Inventory, McGill-Dartmouth Part IV and Short Portable Mental Status Questionnaire. Pain (using linear analog scale), sedation score and narcotic use assessed every 4 hours for 72 hours.


RESULTS
No differences were found in state anxiety or self-perceived mood states. Postoperative state anxiety was found to relate most closely to preoperative anxiety and postoperative complications, rather than method of analgesia or severity of pain. However, patient-controlled analgesia subjects had significantly improved analgesia and increased satisfaction.


CONCLUSIONS
The use of patient-controlled analgesia does not significantly alter the measured psychological parameters, compared with intramuscular injections. Improved analgesia is the result of pharmacologic effects, independent of psychological factors.
Egbert
A M
AM
University of Kansas School of Medicine, Wichita.
Lampros
L L
LL
Parks
L L
LL
D000339:Affect; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000523:psychology; D001007:Anxiety / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D016330:Frail Elderly; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008609:Mental Status Schedule; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D009020:Morphine