Anxiolysis and postoperative pain in patients undergoing spinal anesthesia for abdominal hysterectomy.
OBJECTIVE
The relationship between pain and psychological factors is well known. The aim of the study was to evaluate the influence of lorazepam, given before total abdominal hysterectomy, on postoperative pain control.


METHODS
Sixty patients, enrolled in the study, were defined as either anxious or not anxious when the State/Trait Anxiety Inventory (STAI) score was =/>51 or =/< 50, respectively. The anxious patients were randomly assigned to receive oral lorazepam 0.035 mg/kg the night and 2 h before surgery (Group A), or placebo at the same time (Group B). The not anxious patients were assigned to receive oral lorazepam 0.035 mg/kg the night and 2 h before surgery (Group C), or placebo at the same time (Group D). Anesthesia was performed with subarachnoidal block. Ketorolac was used for postoperative pain. As rescue drug, tramadol was administered using a patient controlled analgesia (PCA) modality. Postoperative pain was assessed during the 24 h after surgery by tramadol consumption.


RESULTS
Tramadol consumption was significantly greater in Group B (216.3+/-58.9 mg) than in Groups A, C and D respectively (150.9+/-28.9 mg; 153.6+/-39.9 mg; 154.4+/-39.9 mg). Group B showed a significantly higher pain score compared to the other groups during the first 8 h. No difference in patient satisfaction with perioperative treatment was noted.


CONCLUSIONS
Preoperative lorazepam reduced perioperative anxiety. This could explain the better postoperative pain control in patients undergoing hysterectomy, a very stressful surgical procedure.
Ciccozzi
A
A
Department of Anaesthesiology and Pain Medicine, University of L'Aquila, L'Aquila, Italy.
Marinangeli
F
F
Colangeli
A
A
Antonacci
S
S
Pilerci
G
G
Di Stefano
L
L
Varrassi
G
G
D000328:Adult; D000368:Aged; D000775:Anesthesia, Spinal; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D020911:Ketorolac Tromethamine / Q000627:therapeutic use; D008140:Lorazepam / Q000627:therapeutic use*; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D010149:Postoperative Pain / Q000517:prevention & control* / Q000523:psychology*; D014147:Tramadol / Q000627:therapeutic use
D014151:Anti-Anxiety Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009294:Narcotics; D014147:Tramadol; D020911:Ketorolac Tromethamine; D008140:Lorazepam