Children with preoperative anxiety may have less pain, take fewer analgesics after surgery
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Key takeaways:
- Mean daily pain scores topped at 4.5 on postoperative day 1 and decreased thereafter.
- Results showed 73% of patients were still taking nonopioid analgesics up to 1 week after surgery.
SAN FRANCISCO — Results presented here showed children with high anxiety scores prior to surgery may have less pain and take fewer analgesics postoperatively.
“While baseline pain-related anxiety is not significantly associated with postoperative outcomes in this study, it did remain a significant concern for many families and children, suggesting that further work is necessary to determine if and to what extent these factors may affect outcomes in the future,” Alex L. Gornitzky, MD, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
Gornitzky and colleagues assessed preoperative anxiety, pain catastrophizing and pain self-efficacy in a baseline survey that was completed by a parent proxy among 63 children aged 5 to 17 years undergoing operative fixation of an isolated lower extremity fracture. Researchers also assessed pain and analgesia consumption on postoperative days 1 to 7, 10, 14 and 21, including both type and number of doses from each analgesic each day. To assess global health and functional recovery, researchers used Patient-Reported Outcome Measurement Information System (PROMIS) measures for global health and mobility.
“Mean daily pain scores peaked at 4.5 on postoperative day 1 and steadily decreased thereafter,” Gornitzky said. “If you break that down into pain categories, you see that most patients had mild pain or less on postoperative day 3 and only one patient reported severe pain greater than seven 1 week after surgery.”
By postoperative day 3, Gornitzky said most patients were no longer taking opioids, including one-third of patients who never took opioids. He added no patients were taking opioids after postoperative day 10.
“Looking at the other analgesics, nonopioid analgesics were used far more commonly. Seventy-three percent of patients were still taking these up to a week after surgery,” Gornitzky said.
Prior to surgery, most caregivers and patients reported pain-related anxiety of six or more, according to Gornitzky.
“Looking specifically at pain self-efficacy, children were more concerned than their parents about their ability to manage pain after surgery and only 50% of kids said that they were at least moderately confident in their ability to adequately manage pain after surgery,” he said.
However, Gornitzky said neither pain-related anxiety nor pain self-efficacy were related to mean daily pain scores or postoperative analgesic consumption.
“Pain anxiety did not appear to affect either opioid use or patient-reported outcomes as measured by the PROMIS scales,” Gornitzky said.
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Gornitzky AL, et al. Paper 496. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Feb. 12-16, 2024; San Francisco.
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