Background and Aims
Inadequate management of postoperative pain is common. In addition to medical and technical factors, pre-surgical guidance and psychological preparation may, also influence the experience of post-operative pain. Our aim is to find out the effect of preoperative structured surgical information and psychological support that the patients received in pain relief after thyroidectomy.
Methods
This prospective study has been conducted in Sohag University Hospitals, in the period from October 2007 to April 2009. Pain intensity was measured in day 1, 2, and 3 postoperatively in 132 patients undergoing thyroidectomy for simple multinodular goitre. They were divided into 4 groups: group (A) with no special surgical or anesthetic information or psychological preparation; group (B) with detailed surgical and anesthetic guidance; group (C) with psychological support; and group (D) with both surgical and anesthetic guidance and psychological support. The consumed analgesics were, also measured collectively in the postoperative three days and compared in the four groups of cases. All patients answered the questionnaire of 4-point scale for pain assessment.
Results
In the postoperative day 1, pain experience was more in group A (1.69±0.47) than in group B (1.50 ± 0.51) and group C (1.56 ± 0.50) and the least experienced pain was in group D (1.09 ± 0.36). In the postoperative day 2, pain experience was, also more in group A (1.47 ± 0.59) than in group B (1.16 ± 0.37) and group C (1.09 ± 0.36) and the least experienced pain was in group D (0.90 ± 0.31). Structured pre-surgical information and psychological preparation were negatively correlated with feeling of postoperative pain and this was statistically highly significant during day 1, 2, and 3 postoperatively (p < 0.001; 0.001; 0.017 respectively).
The mean consumed analgesic ampoules were more in group A (nalbuphine 0.52 ± 0.14, declofenac sodium 0.98 ± 0.31) than in group B (nalbuphine 0.41 ± 0.11, declofenac sodium 0.82 ± 0.32) and group C (nalbuphine. 0.38 ± 0.2, declofenac sodium 0.83 ± 0.17) and the least group consuming analgesics was group D (nalbuphine 0.34 ± 0.91, declofenac sodium 0.63 ± 0.56) and this was statistically highly significant (p <0.001).
Conclusion
Systematic and structured preoperative surgical information and guidance provided by the surgeon, anesthesiologist, psychiatrist and nursing staff positively impacts the intensity of experienced postoperative pain and hence decreases the consumed analgesics and their side effects.