The Use of Adjunct Psychosocial Interventions Can Decrease Postoperative Pain and Improve the Quality of Clinical Care in Orthopedic Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

This study aims to assess the effectiveness of psychosocial techniques to decrease postoperative pain and improve perioperative clinical care in orthopedic surgery. A systematic review and meta-analysis was performed to evaluate the effects of psychosocial methods among adults undergoing orthopedic surgeries. The systematic review included both randomized and nonrandomized trials, but only randomized controlled clinical trials (RCTs) were included in the meta-analysis. Key outcomes were postoperative pain, analgesic requirement, perioperative anxiety, quality of life, and recovery. After searching the databases from January 1980 to September 2016, a total of 62 RCTs were included with a pooled sample size of 4,908. Psychosocial interventions significantly reduced postoperative pain (Hedges’ g?=?0.31 [95% confidence interval = 0.14, 0.48]), and preoperative and postoperative anxiety (g?=?0.26 [0.11, 0.42] and g?=?0.4 [0.21, 0.59], respectively). Furthermore, psychosocial interventions improved recovery (g?=?0.38 [0.22, 0.54]). However, no significant effects were found for postoperative analgesic use (g?=?0.16 [?0.01, 0.32]) and quality of life (g?=?0.14 [?0.05, 0.33]). Patient education and relaxation techniques produced the most consistent positive effects, showing benefits on pain, anxiety, and recovery. Cognitive or behavioral techniques improved recovery. Furthermore, larger effects were found for studies that included acute surgeries compared to elective surgeries. The results indicate that psychosocial interventions, especially patient education and relaxation training, may reduce perioperative side effects and improve recovery in patients undergoing orthopedic procedures, but the quality of evidence is generally low. More well-powered, high-quality studies are needed to increase confidence.

Parental and Child Anxiety Perioperatively: Relationship,Repercussions, and Recommendations

PurposeElective surgical procedures predictably cause stress and anxiety for children and their parents. This can have a negative effect on the child's short-term and long-term psychological and physiological outcomes. This narrative review examines perioperative child anxiety and existing interventions to reduce child and parent perioperative anxiety. The aim was to identify a need and gaps in knowledge for future study.DesignPeer-reviewed articles were examined to identify themes in the literature on interventions in place to reduce child and parent perioperative anxiety and to identify any gaps in knowledge for future study.MethodsA narrative review of 62 peer-reviewed articles was conducted.FindingsEvidence of themes aimed at lowering perioperative child anxiety using medication, cognitive educational, and play therapy approaches emerged through the literature search. A relationship between parental anxiety and the effect on the child's anxiety was supported, yet interventions that target the parent were limited cognitive education interventions and were found to be implemented only in a small number of hospitals.ConclusionsA clear gap is the lack of research on the effects of parental interventions on the short-term and long-term negative behavioral and physiological outcomes of child perioperative anxiety. Research is needed to further explore the effect of a preoperative psychotherapeutic intervention to allow parents to express anxieties and discuss them with a trained professional in the absence of children. A systematic review or further research would help determine if a psychotherapeutic intervention for the parents would lower child anxiety perioperatively.     

Anxiety and Pain in Children Undergoing Surgery: A Scoping Review

PurposeAnxiety and pain are experienced by most children undergoing surgical procedures. Untreated anxiety delays postoperative recovery and also increases the risk of complications. The purpose of this scoping review was to examine the relationship between perioperative anxiety and postoperative pain among children.DesignA scoping reviewMethodsA comprehensive literature search was done on the following databases: PubMed-MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index of Nursing and Allied Health Literature), ProQuest, and Cochrane library to identify the original research studies published in English between January 01, 2000 to March 31, 2021. Two authors independently screened the studies based on pre-specified criteria. The results of the search are described narratively.FindingsA total of eleven studies were included in this review from 1,180 studies initially retrieved. Most of the studies revealed that children who had higher levels of perioperative anxiety experienced higher levels of postoperative pain.ConclusionsThis review identified that perioperative anxiety has a significant effect on postoperative pain among children. The review results indicate the need to develop age-appropriate interventions to reduce perioperative anxiety and postoperative pain among children to reduce further postoperative complications.     

Perioperative Management in Reverse Total Shoulder Arthroplasty

Purpose of ReviewA successful reverse total shoulder arthroplasty requires careful preoperative planning and perioperative management. Preoperative comorbidity risks, perioperative pain management, and postoperative rehabilitation are all critical components of this arthroplasty. The current review examines available literature to guide the perioperative care of the reverse total shoulder arthroplasty patient.Recent FindingsOne of the most important advances for shoulder arthroplasty in recent years has been heightened awareness of various modalities for perioperative pain management. A number of recent studies have focused on the options for regional blockade as a critical tool for postoperative pain relief and the use of either continuous interscalene blocks or single shot blocks are supported. Additional studies are necessary to define the best local anesthetic agent and delivery mechanism to provide appropriate pain relief with a low side effect profile.SummaryManagement of the patient throughout the perioperative course is a critical component in achieving better patient outcomes delivering high quality patient care. An orthopedic surgery team focused on perioperative management is better positioned to decrease adverse events and improve patient outcomes after reverse total shoulder arthroplasty.     

Nursing Music Protocol and Postoperative Pain

Pain has always been a major concern for patients and nurses during the postoperative period. Therapies, medicines, and protocols have been developed to improve pain and anxiety but have undesirable risks to the patient. Complementary and alternative medicine therapies have been studied but have not been applied as regular protocols in the hospital setting. Music is one type of complementary and alternative medicine therapy that has been reported to have favorable results on reducing postoperative pain, anxiety, and opioid usage. However, music lacks a protocol that nurses can implement during the perioperative process. This paper is an in-depth literature review assessing a best practice recommendation and protocol that establishes a consensus in the use of music therapy. The results suggest that music therapy may consist of calming, soft tones of 60-80 beats per minute for at least 15-30 minutes at least twice daily during the pre- and postoperative periods. It is suggested that music only be used in conjunction with standards of care and not as the primary intervention of pain or anxiety. This evidence suggests that proper use of music therapy can significantly reduce surgical pain. Implementing these protocols and allowing the freedom of nursing staff to use them may lead to greater reductions in surgical pain and anxiety and a reduction in opioid use.     

A perioperative education program for pediatric patients and their parents

Preparing pediatric patients for surgery is crucial to positive patient and parent experiences. Through preoperative screening, observation, and postoperative feedback, clinical staff nurses at the Yellowstone Surgery Center (YSC) in Billings, Montana, identified a need to provide increased information to pediatric patients and their parents regarding the surgical process and postoperative expectations for recovery. The director of nursing developed a program for patients that includes preoperative education and a hands-on experience. The YSC Kids program is a customizable program that includes nine initiatives designed specifically for children. The program has been shown to successfully educate pediatric patients and their parents about the entire perioperative process, thus easing their anxiety about an unfamiliar situation.     

Patterns and frequency of anxiety in women undergoing gynaecological surgery

Aims. Within a gynaecological surgical setting to identify the patterns and frequency of anxiety pre‐ and postoperatively; to identify any correlation between raised anxiety levels and postoperative pain; to identify events, from the patients’ perspective, that may increase or decrease anxiety in the pre‐ and postoperative periods. Background. It is well documented that surgery is associated with increased anxiety, which has an adverse impact on patient outcomes. Few studies have been conducted to obtain the patient's perspective on the experience of anxiety and the events and situations that aggravate and ameliorate it. Method. The study used a mixed method approach. The sample consisted of women undergoing planned gynaecological surgery. Anxiety was assessed using the State Trait Anxiety Inventory. Trait anxiety was measured at the time of recruitment. State anxiety was then assessed at six time points during the pre‐ and postoperative periods. Postoperative pain was also measured using a 10 cm visual analogue scale. Taped semi‐structured telephone interviews were conducted approximately a week after discharge. Results. State anxiety rose steadily from the night before surgery to the point of leaving the ward to go to theatre. Anxiety then increased sharply prior to the anaesthetic decreasing sharply afterwards. Patients with higher levels of trait anxiety were more likely to experience higher levels of anxiety throughout their admission. Elevated levels of pre‐ and postoperative anxiety were associated with increased levels of postoperative pain. Telephone interviews revealed a range of events/situations that patients recalled distressing them and many were related to inadequate information. Conclusion. This study found higher rates of anxiety than previously reported and anxiety levels appeared raised before admission to hospital. This has important clinical and research implications. Relevance to clinical practice. Patients with high levels of anxiety may be identified preoperatively and interventions designed to reduce anxiety could be targeted to this vulnerable group. Patient experiences can inform the delivery of services to meet their health needs better.     

Effectiveness of relaxation for postoperative pain and anxiety: randomized controlled trial

Title.  Effectiveness of relaxation for postoperative pain and anxiety: randomizedcontrolled trial
Aim.  This paper is a report of a study to determine the effectiveness of jaw and total body relaxation for postoperative pain, anxiety and level of relaxation, and to determine any patient expectancy effects.
Background.  Relaxation is increasingly suggested as a pain control technique that can be used by nurses in daily practice. A systematic review of the effectiveness of relaxation for postoperative pain relief revealed many poorly designed studies and only some weak evidence supporting the use of relaxation for postoperative pain.
Method.  A randomized controlled trial ( n  =   118) was conducted between 2002 and 2003 to compare total body relaxation, jaw relaxation, attention control and usual care. Consenting patients admitted for elective orthopaedic surgery aged 18 or over, able to speak English and able to tense and relax more than two muscle groups were included. Pain at rest and on movement, anxiety and relaxation were assessed at pre-admission clinic, pre-intervention, immediately post-intervention and 1, 2, 3 and 4 hours later. However, the trial was under-powered.
Findings.  There were statistically significant reductions in pain at rest from pre- to post-intervention for both the relaxation groups and the attention control group. The usual care group had a small increase in pain, whilst the other three groups had similar small decreases in pain. There was no statistically significant difference in anxiety or relaxation scores pre- to post-intervention between groups.
Conclusion.  Jaw relaxation could give these orthopaedic patients a small, very short-lasting additional amount of pain relief, and it may be that staff and patients feel this small benefit to be worthwhile.     

Efectos del uso de un tríptico informativo en la reducción de la ansiedad y el dolor perioperatorios en pacientes intervenidos de patología urológica

IntroductionThe preoperative anxiety state is mainly caused by the fear of the circumstances surrounding the intervention. Anxiety causes increased postoperative pain, and a prolonged length of stay in hospital, which directly affect the cost of care.ObjectiveTo evaluate the effects of providing an anaesthesia information leaflet on postoperative anxiety and pain in patients undergoing urological surgery in the Miguel Servet Hospital.Material and methodsA prospective quasi-experimental study of 100 cases, 51 of whom made up the intervention group who received the information leaflet, with the remaining 49 cases being in the control group. The Hospital Anxiety and Depression Scale and the visual analogue scale for pain were assessed in both groups, before and after surgery.ResultsOf the 100 patients, 72% were male and 28% female, with an average age of 67.3 years (standard deviation, 9.7). In the intervention group, 21.6% showed anxiety before surgery and 0% in the postoperative period. In the control group 30.6% presented anxiety during the preoperative period and 4% in the postoperative period (χ² Pearson 5.20, P = .023). The study showed a direct relationship between preoperative anxiety and postoperative pain (χ² Pearson 10.519, P = .001).ConclusionsGood information about the surgical process reduces anxiety levels in the postoperative period.     

The Effect of Different Audio Distraction Methods on Children's Postoperative Pain and Anxiety

PurposeThe aim of the study was to determine the effect of different auditory methods of attention distraction on postoperative pain and anxiety in children.DesignThe study was conducted as a pretest–posttest experimental study to determine the effect of classical music, Turkish music, and audiobook on the reduction of postoperative pain and anxiety in children.MethodsThe patient population of the study comprised children who had undergone a surgical operation in the pediatric surgery clinics. A total of 90 children were included in the sample of the study. The data were collected using the Visual Analog Scale, the Wong-Baker Faces Pain Scale, and the State-Trait Anxiety Inventory for children, in addition to the sociodemographic data form of the child and the parent.FindingsClassical music, Turkish music, and audiobook methods played an effective role in decreasing postoperative pain and the anxiety state in children. Classical music listening was the most effective method in reducing the pain in children in the postoperative period in the three groups in the study.ConclusionsWe demonstrated that different auditory attention distraction methods had a decreasing effect on postoperative pain and anxiety in children.     

护理干预对甲状腺肿瘤手术患者应激反应的影响

目的探讨护理干预对甲状腺肿瘤手术患者应激反应的影响。方法将132例甲状腺肿瘤手术患者随机分为试验组和对照组,每组66例。对照组采用常规护理;试验组在常规护理基础上采用术前、术中和术后护理干预。观察2组患者干预前后焦虑抑郁情况﹑术中疼痛情况、术中手术体位耐受情况及术后头痛、呕吐发生率。结果经过护理干预后试验组患者焦虑抑郁评分较干预前均有明显的降低（P〈0.01）,对照组无明显变化（P〉0.05）。术中总疼痛率试验组为7.6%,对照组为65.1%,2组相比差异有统计学意义（P〈0.01）。试验组术中体位耐受差比例及术后头痛、呕吐发生率与对照组比较均明显降低,2组相比差异均有统计学意义（P〈0.05）。结论护理干预可缓解甲状腺肿瘤手术患者焦虑抑郁情绪,减轻术中疼痛,预防或减轻患者术后头晕、头痛、呕吐、腰背痛等不适,提高患者术后舒适度,使患者更好地适应和配合手术,利于术后康复,是一项切实可行的护理模式。     

Perioperative uses of low-dose ketamine for pain management.

The purpose of this article is to explore the most current literature regarding perioperative pain management uses of low-dose ketamine. Research has demonstrated significant reductions in postoperative pain scores as well as opioid consumption with low-dose ketamine administration without side effects associated with its induction doses. The availability of S(+)-ketamine with double the analgesic potency of ketamine will create even more reason for its use.     

The role of COX-2 inhibitors in the perioperative setting: efficacy and safety--a systematic review

A new class of nonsteroidal anti-inflammatory drugs (NSAIDs) selective for cyclooxygenase-2 (COX-2) offers new options for managing perioperative pain. However, new and conflicting data have emerged regarding all nonsteroidal anti-inflammatory drugs, including those selective for COX-2. The data highlight the potential for increased risks of adverse cardiovascular events associated with all NSAIDs and of potential serious skin reactions and gastrointestinal bleeding with specific agents. As of June 2005, the National Institutes of Health and Food and Drug Administration suspended all clinical trials involving NSAIDs. This article reviews 30 prospective studies on the role of COX-2 selective inhibitors in the perioperative setting. The studies examined a variety of variables, including efficacy, perioperative opioid reduction, and effects on platelet aggregation and renal function. The data reveal an overall reduction in postoperative opioid use and significant patient satisfaction with perioperative COX-2 use, no effect on platelet aggregation, and a minor negative effect on renal function. The literature suggests that perioperative use of selective COX-2 inhibitors can be well tolerated and efficacious in carefully selected patient groups. Further data are needed to fully examine the role of these drugs in the perioperative setting. Intensive research into cardiovascular issues surrounding all NSAIDs is warranted.     

腹部手术患者术前焦虑对术后疼痛及镇痛药用量的影响

目的研究全身麻醉腹部手术患者术前焦虑对术后疼痛、镇痛药用量及对术后镇痛满意度的影响。方法选取2009年8月-2010年4月68例ASAⅠ～Ⅱ级,拟行气管插管全身麻醉的腹部手术患者,术前采用状态-特质焦虑量表和抑郁评分量表进行焦虑程度的测评,术后观察VAS疼痛评分、总的镇痛药用量以及患者对镇痛的满意度,分析术前焦虑与术后VAS评分、镇痛药用量及镇痛满意度的相关性。结果 68例受试者术前STAI为50±13,BDI为16±13,术后VAS评分为4.0±2.1,术后24h镇痛药芬太尼的用量为（0.80±0.21）mg;术后镇痛药用量、患者镇痛满意度评分与术前STAI明显相关（r=0.68和r=-0.88,P〈0.01）。术后VAS评分与术前STAI及BDI也有一定的相关（r=0.35和r=0.3）。结论术前焦虑程度可以影响腹部手术患者对镇痛治疗的满意度,显著增加镇痛药用量。     

卵巢癌化疗患者焦虑、抑郁原因的质性研究

目的了解卵巢癌化疗患者焦虑、抑郁的原因,为制订有针对性的护理措施提供依据。方法采用质性研究中的现象学方法,对10例卵巢癌进行访谈,采用内容分析法对访谈资料进行分析。结果卵巢癌患者围手术期焦虑、抑郁的原因是自身心理障碍、对家人的牵挂和内疚、夫妻关系发生变化、经济负担加重和自我价值感降低等。结论针对患者焦虑、抑郁的原因,制订和实施个性化的护理干预措施,消除患者的焦虑、抑郁症状,促进患者积极配合治疗,从而提高治疗效果和生活质量。     

The Effect of Hand Massage on Preoperative Anxiety in Ambulatory Surgery Patients

Anxiety in patients awaiting surgery and diagnostic procedures in an ambulatory department can affect the patient’s physiological and psychological well-being and outcome. We conducted a quasi-experimental study at a midwestern US community hospital to determine the effects of hand massage on patient anxiety in the ambulatory surgery setting. We also investigated whether adding the hand massage procedure affected the timing and flow of procedures. The results indicated that hand massage reduces anxiety for patients awaiting ambulatory surgery and outpatient procedures. Participants who received hand massage experienced lower anxiety levels than those who received customary nursing care. In addition, the performance of hand massage did not affect the flow or timing of procedures. Hand massage is an easy procedure for nurses to learn and administer, and it is within the scope of perioperative nursing practice.     

Pain and anxiety management in the postoperative gastro-surgical setting

BACKGROUND: Despite increasing knowledge and technological advances, patients continue to experience pain and anxiety in the postoperative setting. AIM OF THE STUDY: The aim of this study was to examine how nurses managed patients' pain and anxiety within the gastro-surgical hospital setting. METHODS: An observational design was selected to examine nurses' management of postoperative patients' pain and anxiety. Six nurses who were involved in direct patient care in one of two gastro-surgical wards in a public teaching hospital in Melbourne, Australia, were randomly selected to participate. The observation period comprised a fixed 2-hour segment, and each nurse was observed on three different occasions. FINDINGS: Patient assessment was a major concern for participants, which was influenced by the modes of assessment used, patients' medical condition and operation procedure, and their self-reports of pain or anxiety. Communication with health care professionals and policy and protocol concerns also affected nurses' pain and anxiety management decisions. Formal communication through the multidisciplinary ward round tended to be somewhat fragmented, as the medical consultant did not seek out the bedside nurse. Nurses had good knowledge of unit policies and protocols and, while attempting to enforce them, spent considerable time encouraging medical colleagues to abide by these guidelines. Finally, nurses made complex clinical judgements which extended beyond the administration of analgesics or antianxiety drugs. STUDY LIMITATIONS: It is possible that nurses demonstrated a raised awareness of how they managed patients' pain and anxiety during observation periods. CONCLUSIONS: The study confirmed the importance of examining the complexities of the clinical context in determining how nurses manage pain and anxiety in the postoperative setting.     

Using music interventions in perioperative care

ABSTRACT: Anxiety and pain are common responses to surgery, and both can negatively affect patient outcomes. Music interventions have been suggested as a nonpharmacological intervention to alleviate pain and anxiety during surgical treatment. Although the data are somewhat mixed, the research suggests that music-based interventions are effective in reducing anxiety, pain perception, and sedative intake. The majority of studies have focused on interventions during the postoperative period and address pain reduction, with preoperative use of music targeting anxiety reduction the second most commonly cited objective. Most of the studies found in the literature involve passive music listening via headphones. The data suggest that researcher-selected music is most effective in reducing anxiety, primarily because it incorporates evidence-based parameters such as consistent tempo and dynamics, stable rhythms, and smooth melodic lines. Finally, the literature suggests that music therapists can serve as experts to help medical personnel identify effective implementation strategies.     

Abdominal surgery, pain and anxiety: preoperative nursing intervention

AIM: This paper reports a study examining the effects of preoperative nursing intervention for pain on abdominal surgery preoperative anxiety and attitude to pain, and postoperative pain. METHOD: In a randomized controlled study conducted between January and August 2001, patients undergoing abdominal surgery in a medical center in southern Taiwan were randomly assigned to an experimental (n = 32) or control group (n = 30). The experimental group received routine care and preoperative nursing intervention for pain, while the control group received routine care only. A structured questionnaire including an anxiety scale, pain attitude scale, and Brief Pain Inventory was used to assess the results. RESULTS: Participants in the experimental group experienced a significant decrease in preoperative anxiety and a significant improvement in preoperative pain attitude. They also had statistically significantly lower postoperative pain intensity for 4 hours after surgery and lower highest pain intensity within the first 24 hours after surgery. Perceived pain interference during position changes, deep breathing/coughing, and moments of emotion in the experimental group was statistically significantly lower than that of the control group in the same situations. The experimental group also started out-of-bed activities 1.5 days earlier. CONCLUSION: Preoperative nursing intervention for pain has positive effects for patients undergoing abdominal surgery. The intervention used in this study could serve as a guide for nurses to improve the pain care of these patients.     

The anxiety- and pain-reducing effects of music interventions: a systematic review

MUSICAL INTERVENTIONS have been used in health care settings to reduce patient pain, anxiety, and stress, although the exact mechanism of these therapies is not well understood.THIS ARTICLE PROVIDES A SYSTEMATIC review of 42 randomized controlled trials of the effects of music interventions in perioperative settings.MUSIC INTERVENTION HAD POSITIVE effects on reducing patients' anxiety and pain in approximately half of the reviewed studies.FURTHER RESEARCH into music therapy is warranted in light of the low cost of implementation and the potential ability of music to reduce perioperative patient distress. AORN J 87 (April 2008) 780-807. © AORN, Inc, 2008.