The effect of preoperative anxiety on post-operative pain in patients undergoing elective surgery

Abstract

Objective: To evaluate the effect of preoperative anxiety on postoperative pain scores, and postoperative analgesic requirements in adult surgical patients.

Methods: This prospective cohort study included 370 patients undergoing elective surgery, equally divided into low and high preoperative anxiety groups (n = 185 each) based on standardized anxiety assessment. Demographic characteristics, clinical variables, type of surgery, anesthesia technique, intraoperative opioid consumption, duration of surgery, postoperative Numerical Rating Scale (NRS) pain scores at 2, 4, 6, 12, and 24 hours, and total 24-hour postoperative tramadol consumption were recorded. Comparisons between groups were performed using independent t-tests and chi-square tests, with p < 0.05 considered statistically significant.

Results: The mean age was comparable between the low and high anxiety groups (41.78 ± 9.48 vs 40.50 ± 9.40 years; p = 0.191), with no significant differences in gender distribution or educational status. A significantly higher proportion of rural patients (p = 0.048) and ASA III status (p = 0.042) was observed in the high anxiety group. General anesthesia was used more frequently in patients with high anxiety (67.0% vs 56.8%; p = 0.042). Mean intraoperative opioid consumption was significantly higher in the high anxiety group (105.71 ± 17.44 mg vs 95.79 ± 15.38 mg; p < 0.001). Postoperative NRS pain scores were significantly higher in the high anxiety group at all time points (2–24 h; all p < 0.001). Total 24-hour postoperative tramadol consumption was also significantly greater in patients with high preoperative anxiety (159.86 ± 15.88 mg vs 135.04 ± 23.44 mg; p < 0.001).

Conclusion: High preoperative anxiety is associated with increased intraoperative opioid use, higher postoperative pain scores, and greater postoperative analgesic requirements. Routine assessment and management of preoperative anxiety may improve postoperative pain outcomes and optimize perioperative analgesic strategies.