Preoperative psychologic and demographic predictors of pain perception and tramadol consumption using intravenous patient-controlled analgesia.
OBJECTIVE
Postoperative pain is characterized by a wide variability of patients' pain perception and analgesic requirement. The study investigated the extent to which demographic and psychologic variables may influence postoperative pain intensity and tramadol consumption using patient-controlled analgesia (PCA) after cholecystectomy.


METHODS
Eighty patients, aged 18 to 70 years, with an American Society of Anesthesiologists physical status I or II and a body mass index between 18.5 and 24.9, undergoing laparoscopic cholecystectomy were enrolled. Self-rating anxiety scale (SAS) and self-rating questionnaire for depression (SRQ-D) were used--1 day before surgery--to assess patients' psychologic status. General anesthesia was standardized. PCA pump with intravenous tramadol was used for a 24-hour postoperative analgesia. Visual analog scale at rest (VASr) and after coughing (VASi) and tramadol consumption were registered. Pearson's and point biserial correlations, analysis of variance, and step-wise regression were used for statistical analysis.


RESULTS
Pearson r showed positive correlations between anxiety, depression, and pain indicators (P<0.05). Moreover, female patients had higher pain indicators (P<0.05). Analysis of variance showed that anxious (P<0.05) and depressed (P<0.001) patients had higher pain indicators, which significantly decreased during the postoperative 24 hours (P<0.00001). Regression analysis revealed that tramadol consumption was predicted by preoperative depression (P<0.001). VASr was predicted by sex and SRQ-D (P<0.05). VASi was predicted by sex and SAS (P<0.05).


CONCLUSIONS
Pain perception intensity was primarily predicted by sex with an additional role of depression and anxiety in determining VASr and VASi, respectively. Patients with high depression levels required a larger amount of tramadol.
De Cosmo
Germano
G
Department of Anaesthesiology and Intensive Care, Policlinico Universitario A. Gemelli, Rome, Italy. gdecosmo@rm.unicatt.it
Congedo
Elisabetta
E
Lai
Carlo
C
Primieri
Paolo
P
Dottarelli
Alessandra
A
Aceto
Paola
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000523:psychology* / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010147:Pain Measurement / Q000187:drug effects* / Q000523:psychology; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D011300:Preoperative Care / Q000523:psychology / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014147:Tramadol / Q000008:administration & dosage*; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D014147:Tramadol