Elsevier

Journal of Pediatric Health Care

Volume 31, Issue 1, January–February 2017, Pages 5-15
Journal of Pediatric Health Care

Article
Preoperative Distress Factors Predicting Postoperative Pain in Adolescents Undergoing Surgery: A Preliminary Study

https://doi.org/10.1016/j.pedhc.2015.12.008Get rights and content

Abstract

The purpose of this study was to determine if preoperative distress factors could be used as predictors of postoperative pain in adolescents scheduled for spinal fusion surgery. Patients reporting the presence of pain before surgery reported greater pain intensity at postoperative day (POD) 1 (p = .033), POD 2 (p = .008) and at follow-up 6 weeks after surgery (p = .0001). Preoperative trait anxiety was associated with pain intensity before surgery (p = .002) but not with postoperative pain intensity (p > .05). Salivary cortisol concentrations did not differentiate between anxious and nonanxious patients based on anxiety trait (p = .21) and was not associated with postoperative pain intensity (p > .05). These findings suggest that preoperative distress factors do not predict postoperative pain intensity in the acute and intermediate period. The presence of preoperative pain was the best predictor of postoperative pain intensity, suggesting that preoperative pain assessment will identify patients at an elevated risk for intense postoperative pain.

Section snippets

Methods

Ethics approval was obtained prior to the beginning of the study from the Research Ethics Board of McGill University. Written informed patient assent and parental consent were obtained prior to the beginning of the study. A description of the experimental design is provided in Table 1.

Study Population

A total of 58 adolescents diagnosed with AIS were enrolled in the study. Thirty-eight female and five male patients scheduled to undergo spinal fusion surgery were recruited for the study arm. All surgical patients underwent a classic posterior spinal fusion either across the thoracic and/or the lumbar spine. The control group consisted of 13 female and 2 male patients with AIS who were followed up in the clinic for scoliosis but were not scheduled for surgery.

Comparison of Preoperative (Baseline) Variables Between Groups

Baseline psychological assessment

Discussion

The goals of this preliminary study were to (a) understand the relationship between psychological and physiological dimensions of distress and self-reported pain intensity before a surgical procedure and (b) to assess the predictive roles of these variables on postoperative pain intensity. Compared with control subjects not scheduled for surgery, the anticipation of upcoming surgery was associated with significantly higher self-reported state anxiety. No other differences were observed between

Conclusion

The quest to find predictors of which patients are at greater risk of having chronic postsurgical pain is of high relevance in pediatrics. In adolescent patients scheduled for spine surgery, salivary cortisol was significantly increased just before entering the operating room but was not associated with the baseline state or trait anxiety of patients or with postoperative pain at any time point. Preoperative pain intensity was the only variable measured that was associated with postoperative

Catherine E. Ferland, Postdoctoral Fellow, Shriners Hospital for Children–Canada; Department of Surgery, McGill University; McGill Scoliosis & Spine Research Group; Alan Edwards Centre for Research on Pain, McGill University; and Faculty of Dentistry, McGill University, Montreal, Canada.

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    Catherine E. Ferland, Postdoctoral Fellow, Shriners Hospital for Children–Canada; Department of Surgery, McGill University; McGill Scoliosis & Spine Research Group; Alan Edwards Centre for Research on Pain, McGill University; and Faculty of Dentistry, McGill University, Montreal, Canada.

    Neil Saran, Orthopedic Surgeon, Shriners Hospital for Children–Canada; Department of Surgery, McGill University; McGill Scoliosis & Spine Research Group; and McGill University Health Centre, Montreal, Canada.

    Teresa Valois, Anesthesiologist, McGill University Health Centre, Montreal, Canada.

    Sheila Bote, Research Nurse, Shriners Hospital for Children–Canada; and McGill Scoliosis & Spine Research Group, Montreal, Canada.

    Jill M. Chorney, Child Psychologist, IWK Health Centre, Halifax, Canada.

    Laura S. Stone, Associate Professor, McGill Scoliosis & Spine Research Group; Alan Edwards Centre for Research on Pain, McGill University; Department of Anesthesia, McGill University; Department of Pharmacology and Therapeutics, McGill University; and Faculty of Dentistry, McGill University, Montreal, Canada.

    Jean A. Ouellet, Orthopedic Surgeon, Shriners Hospital for Children–Canada; Department of Surgery, McGill University; McGill Scoliosis & Spine Research Group; Alan Edwards Centre for Research on Pain, McGill University; and McGill University Health Centre, Montreal, Canada.

    Financial support provided by the Louise and Alan Edwards Foundation (to JAO, CEF and LSS), the Canadian Institutes of Health Research (MOP126046 to LSS and CEF, MOP102586 to LSS, and MOP192333 to JMC and JAO), and the Shriners Hospitals (CAN84292 to JAO and CEF). CEF received fellowships from the CIHR-NeuroInflammation training program, the Quebec Network for Oral and Bone Health, les Fonds de Recherche du Québec-Santé, and the Shriners Hospitals for Children.

    JAO has received lecture fees and funding from DePuy Synthes, Zuchwil, Switzerland. None of the other authors has conflicts of interest to report.

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