Anxiety and Depression Affect Early Postoperative Pain Dimensions after Bariatric Surgery

Does Weather Have an Influence on Pain in Patients With Arthroplasty?

BACKGROUND

Patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) often report fluctuations in pain levels associated with weather conditions. Despite common clinical observations, the literature remains inconclusive. This study aimed to evaluate the correlation between postoperative pain scores and weather parameters, considering demographic and comorbidity factors.

METHODS

A retrospective chart review was conducted on 558 patients who underwent TKA or THA between January 1, 2020 and December 31, 2023. Patients without significant comorbidities affecting surgical outcomes were included. Postoperative pain scores recorded using a numerical rating scale were correlated with historical weather data (temperature, barometric pressure, humidity) and compared to the entire group (both TKA and THA) and to subgroups (TKA or THA).

RESULTS

The mean pain score reported was 3.87. Weather parameters, including temperature and barometric pressure, did not yield significant results with pain scores. Analysis revealed a significant negative correlation between age and pain scores (r = -19 0.293, p < 0.001), indicating that older patients reported lower pain levels. Body mass index (BMI) was positively correlated with pain scores (p < 0.05), while sex and race/ethnicity showed no significant associations (p > 0.05). Notably, mental health diagnoses significantly influenced pain ratings (p < 0.05).

CONCLUSIONS

This study found no significant relationship between postoperative pain and weather parameters in patients who underwent TKA/THA, challenging common assumptions that weather significantly influences pain perception. However, age, BMI, and mental health were identified as significant factors affecting postoperative pain experiences. These findings underscore the need for personalized pain management strategies that account for individual patient characteristics.

Preoperative Mental Disorders and Hospital Healthcare Use in the First Year After Metabolic Bariatric Surgery: A Retrospective Study

BACKGROUND

Mental disorders are relatively common in individuals who undergo metabolic bariatric surgery (MBS). Prior research suggests that mental disorders may relate to increased healthcare use after MBS. We retrospectively explored the association between preoperative mental health disorders and healthcare use in the first postoperative year.

METHODS

Patients who underwent primary MBS and had a structured preoperative psychological assessment report were included. Data on healthcare use was collected as the total number of non-routine healthcare appointments including inpatient, outpatient, and emergency department visits. Additionally, gastrointestinal (GI) healthcare use at the radiology, gastroenterology, and emergency departments was analyzed separately.

RESULTS

Of the 944 included patients, 261 (28%) had a preoperatively diagnosed mental disorder. Most prevalent were depressive disorders, anxiety disorders, and eating disorders. Patients with a preoperative mental disorder had a 15% (adjusted, CI 1.04-1.27, p = 0.005) higher rate of total healthcare use compared to those without. Among patients who had any GI-related healthcare, those with a mental disorder had a 61% higher rate of GI-related healthcare use (CI 1.02-2.55, p = 0.041). Patients with a mental disorder tended to have 20% lower odds of having no GI-related healthcare appointments (unadjusted, not statistically significant, CI 0.37-1.74, p = 0.568).

CONCLUSION

The presence of preoperative mental disorders was weakly related to higher total non-routine hospital healthcare use in the first year after MBS. Models explained only 5-13% of the variation in appointment frequency, meaning unmeasured and/or unknown factors play a role in healthcare use.

Association of Untreated Pre-surgical Depression With Pain and Outcomes After Spinal Surgery

Study DesignProspective Cohort Study.ObjectiveUntreated pre-surgical depression may prolong post-surgical pain and hinder recovery. However, research on the impact of untreated pre-surgical depression on post-spinal surgery pain is lacking. Therefore, this study aimed to assess pre-surgical depression in patients and analyze its relationship with post-surgical pain and overall post-surgical outcomes.MethodsWe recruited 100 patients scheduled for lumbar spine surgery due to spondylolisthesis, degenerative lumbar disc diseases, and herniated lumbar disc diseases. Psychiatrists evaluated them for the final selection. We assessed the Beck Depression Inventory (BDI), Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), and EuroQoL 5 Dimensions (EQ-5D) scores, numerical back and leg pain scales, and medication dosage data collected before and at 6 weeks, 3 months, and 6 months after surgery.ResultsNinety-one patients were included in this study; 40 and 51 were allocated to the control and depression groups, respectively. The pre- and post-surgical leg pain, back pain, and functional scores were not different. However, the depression group showed higher ODI and EQ-5D and lower JOA scores than the control group 3 months post-surgery. Partial correlation analysis revealed an inverse correlation between the JOA and BDI scores and a positive correlation between the EQ-5D and BDI scores at 3 months postoperatively.ConclusionUntreated depression can prolong postoperative pain and hinder recovery. Detecting and treating depression in patients before spine surgery may improve their overall quality of life and functional recovery.

Preoperative Surgical Fear, Postoperative Pain, and Sleep Quality in Metabolic and Bariatric Surgery Patients: A Descriptive and Correlational Study

BACKGROUND

This study aimed to determine the preoperative surgical fear levels, postoperative pain intensity, and sleep quality of metabolic and bariatric surgery patients and to examine the relationship between them.

METHODS

This study was a single-center descriptive and correlational design and was completed with 115 patients. The data of the study were collected by using the Personal Information Form, Surgical Fear Questionnaire, Richards-Campbell Sleep Questionnaire, and Visual Analog Scale. Descriptive statistics, Pearson correlation, and multiple linear regression analysis were used for data analysis.

RESULTS

In the study, the mean total score of the preoperative Surgical Fear Questionnaire was 24.73 ± 16.32, and the mean total score of the Richards-Campbell Sleep Questionnaire on the 1st postoperative day was 53.85 ± 20.53. The mean postoperative pain intensity scores were 7.44 ± 1.74 at the 1st hour, 5.19 ± 1.61 at the 12th hour, and 3.24 ± 1.85 at the 24th hour. In addition, it was determined that surgical fear and postoperative pain significantly predicted sleep quality (p < 0.05).

CONCLUSIONS

It was determined in the study that sleep quality decreased as the level of surgical fear and pain intensity of the patients increased. Considering the relationship between fear of surgery, postoperative pain, and sleep quality, it may be beneficial to develop support and counseling services for patients according to current guidelines.

Preoperative psychological distress and acute postoperative pain among abdominal surgery patients

OBJECTIVE

To analyze preoperative psychological distress symptoms and their association with acute postoperative pain in patients undergoing abdominal surgery.

METHOD

Prospective observational study conducted at a University Hospital in Minas Gerais, Brazil. The sample included 118 patients in the hospital's elective abdominal surgery program. Psychological distress symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Pain levels were measured using the numeric verbal scale (NVS, 0-10 points) from admission to discharge from the post-anesthesia care unit. Descriptive statistics and an ordinal regression model were utilized to detect related factors, with a threshold for significance established at p < 0.05. Pain levels at discharge from the post-anesthesia care unit was considered the outcome variable.

FINDINGS

Preoperatively, 50.8 % exhibited symptoms of anxiety (HADS-A ≥ 8) and 16.1 % exhibited symptoms of depression (HADS-D ≥ 8), with 14.4 % presenting both symptoms. The prevalence of pain (NVS >0) in the post-anesthesia care unit was 40.3 %. At admission, 5.8 % of patients reported moderate to severe pain (NVS ≥ 4), increasing to 29.7 % at 60 min and 22.1 % at discharge. Regression analysis showed that anxiety or depression (OR = 4.49, p < 0.01) significantly increased the likelihood of experiencing higher pain levels, which was even greater when both symptoms coexisted (OR = 10.19, p < 0.01). Additionally, older age (OR = 0.94, p < 0.01) and inadequate pain management (OR = 7.67, p < 0.01) were significant predictors of pain levels at discharge.

CONCLUSION

Preoperative psychological distress, particularly the simultaneous presence of anxiety and depressive symptoms, significantly elevates the likelihood of heightened pain intensity in patients undergoing abdominal surgery.

Establishment and Validation of Risk Prediction Models for Postoperative Pain After Endoscopic Submucosal Dissection: A Retrospective Clinical Study

Objective

Postoperative pain is a common complication in endoscopic submucosal dissection (ESD) patients. This study aimed to develop and validate predictive models for postoperative pain associated ESD.

Methods

We retrospectively constructed a development cohort comprising 2162 patients who underwent ESD at our hospital between January 2015 and April 2022. The dataset was randomly divided into a training set (n = 1541) and a validation set (n = 621) in a 7:3 ratio. The bidirectional stepwise regression with Akaike's information criterion (AIC) and multivariate logistic regression analysis were used to screen the predictors of post-ESD pain and construct three nomograms. We evaluated the model's discrimination, precision and clinical benefit through receiver operating characteristic (ROC) curves, calibration plots, Hosmer-Lemeshow (HL) goodness-of-fit test and decision curve analysis (DCA) in internal validation.

Results

The proportion of patients developing postoperative pain in the training and testing data set was 25.6% and 28.5%, respectively. Three nomograms were constructed according to the final logistic regression models. The clinical prediction models for preoperative risks, preoperative and intraoperative risks, and perioperative risks consisted of seven, nine and six independent predictors, respectively, after bidirectional stepwise elimination. The models demonstrated the AUC of 0.794 (95% CI 0.768-0.820), 0.823 (95% CI 0.799-0.847) and 0.817 (95% CI 0.792-0.842) in the training cohort and 0.702 (95% CI 0.655-0.748), 0.705 (95% CI 0.659-0.752) and 0.747 (95% CI 0.703-0.790) in the validation cohort. The calibration plot, HL and DCA demonstrated the model's favorable clinical applicability.

Conclusion

We developed and validated three robust nomogram models, which might identify patients at risk of post-ESD pain and promising for clinical applications.

Patients' perioperative experiences of an opioid-free versus opioid-based care pathway for laparoscopic bariatric surgery: A qualitative study

BACKGROUND

Despite recent evidence supporting the adoption of opioid-free anaesthetic and analgesic alternatives in the perioperative context, opioid-based regimens remain standard of care. There is limited knowledge about the patients' perioperative experiences of bariatric surgery, with no study yet investigating their experiences within an opioid-free care pathway.

OBJECTIVE

We aimed to describe similarities and differences in patients' perioperative experiences of undergoing bariatric surgery with either an opioid-free or opioid-based care pathway.

DESIGN

A qualitative interview study.

SETTING

A strategic sample of patients enrolled in an ongoing randomized controlled trial investigating the effects of opioid-free anaesthesia for bariatric surgery were recruited. In the randomized controlled trial, participants were randomized to either opioid-based anaesthesia or opioid-free anaesthesia, including transcutaneous electrical nerve stimulation as primary postoperative pain management.

PARTICIPANTS

Twenty patients were interviewed 3 months after surgery: 10 participants in the opioid-free group versus 10 in the opioid-based group.

METHODS

Semi-structured interviews were conducted between December 2020 and February 2022 and analysed with qualitative content analysis.

RESULTS

The analysis yielded four categories and 12 subcategories. In Category 1, participants shared diverse emotions before surgery, including anticipation of a healthier life, but also apprehensions and feelings of failure. In Category 2, describing liminality of general anaesthesia, there were similar descriptions of struggling to remember the anaesthesia induction and struggling to surface when recovering from anaesthesia. However, some participants in the opioid-free group shared descriptions of struggling to keep control, describing accentuated memories of the anaesthesia induction. Category 3, managing your pain, showed similar experiences and strategies but different narrations of pain management, with the opioid-free group stating that transcutaneous electrical nerve stimulation works but not when it really hurts, and the opioid-based group describing confidence in but awareness of opioids. Throughout the overall perioperative time period, participants acknowledged Category 4, a patient-professional presence, stating that preparations boost the feeling of confidence before surgery and that they felt confidence in a vulnerable situation although vulnerability challenges communication.

CONCLUSIONS

We highlighted the overall similarities in perioperative experiences of patients undergoing bariatric surgery. However, the differences in experiences during opioid-free anaesthesia induction need to be addressed in further implementation and research studies investigating strategies to reduce the sense of loss of control. More research is needed to facilitate the implementation of opioid-free treatment strategies into clinical practice and improve the patient care experience.

Maternal and fetal/neonatal outcomes in pregnancy, delivery and postpartum following bariatric surgery and comparison with pregnant women with obesity: a study protocol for a prospective cohort

BACKGROUND

Being obese can lead to various complications during pregnancy, such as Gestational Diabetes Mellitus (GDM), pregnancy induced hypertension (PIH), Pre-Eclampsia (PE), and Large Gestational Age (LGA). Although bariatric surgery is an effective way to treat obesity, it can also result in complications and may be linked to having small for gestational age (SGA) babies. This cohort study protocol aims to compare the maternal and fetal/neonatal outcomes of two groups of Iranian pregnant women: those who have undergone bariatric surgery and those who are obese but have not had bariatric surgery.

METHODS

In this study Pregnant women (< 14 weeks' gestation) (n = 38 per group) are recruited either from one of the obesity clinic (exposure group = with a history of bariatric surgery) or primary healthcare clinics in Tehran city (comparison group = pregnant women with obesity and and no history of bariatric surgery). Dietary intake and nutrient status are assessed at < 14, 28, and 36 weeks. Maternal and fetal/neonatal outcomes are compared between the two groups, including gestational diabetes, preeclampsia, preterm labor, intrauterine growth restriction, severe nausea and vomiting, abortion, placenta previa and abruption, venous thrombosis, vaginal bleeding, cesarean delivery, meconium aspiration, and respiratory distress. Maternal serum levels of ferritin, albumin, zinc, calcium, magnesium, selenium, copper, vitamins A, B9, B12, and 25-hydroxy Vit D are checked during 24th to 28th weeks. Maternal and neonatal outcomes, including height, weight, head circumference, fetal abnormality, infection, small or large fetus, low birth weight, macrosomia, NICU admission, and total weight gain during pregnancy, are measured at birth. Maternal and offspring outcomes, including weight, height, head circumference, total weight gain during pregnancy, newborn diseases, postpartum bleeding, breastfeeding, and related problems, are assessed 6 weeks after delivery. Child's weight, height, and head circumference are followed at 2, 4, 6, 8, 10, and 12 months after birth. Maternal stress, anxiety, and depression are assessed with the DASS-21 questionnaire, and physical activity is evaluated using the PPAQ questionnaire in the first and third trimesters.

DISCUSSION

By assessing the levels of micronutrients in the blood of pregnant women along with the evaluation of pregnancy outcomes, it is feasible to gain a more accurate understanding of how bariatric surgery affects the health and potential complications for both the mother and the fetus/newborn. This information can help specialists and patients make more informed decisions about the surgery. Additionally, by examining issues such as stress, anxiety, and depression in women undergoing surgery, this study can contribute to recognizing these problems, which can also affect pregnancy outcomes.

Intraoperative pain prediction of percutaneous kyphoplasty under local anesthesia by preoperative experimental pain assessment

BACKGROUND

Percutaneous kyphoplasty (PKP) is the preferred treatment for osteoporotic vertebral compression fractures (OVCF) Currently, the preoperative anesthesia methods for PKP are mainly local anesthesia and tracheal intubation general anesthesia.

OBJECTIVE

To assess whether patient sensitivity to pain measured preoperatively could predict the patients' pain response during PKP treatment under local anesthesia, to facilitate the development of an optimal preoperative anesthesia plan for patients.

METHODS

Fifty-five female patients diagnosed with osteoporotic single vertebral fracture who were treated with PKP under local anesthesia were selected. The patients' pain sensitivities, including pain threshold and pain tolerance threshold, were evaluated with a pain test device on the day before the operation in the ward. Heart rate (HR), mean arterial pressure (MAP), and blood oxygen saturation (SpO2) were recorded before anesthesia, post-anesthesia, after needle puncture, and after balloon dilatation. At the same time, blood was drawn at the above time points to determine the level of norepinephrine (NA) as an indicator of intraoperative pain stress response. The numerical rating scale (NRS) during surgery was recorded at the end of the surgery.

RESULTS

The preoperative pain tolerance threshold of 55 surgical patients was correlated with the intraoperative NRS score (r=-0.768, P< 0.001), as well as with the preoperative and intraoperative changes in HR (r=-0.791, P< 0.001), MAP (r=-0.819, P< 0.001), and NA (r=-0.553, P< 0.001). Thus, the lower the preoperative pain tolerance threshold, the more severe the patient's response to pain during PKP treatment under local anesthesia, and the greater the hemodynamic changes. Consequently, the intraoperative experience becomes worse. However, there was no correlation between preoperative pain threshold and NRS scores (r=-0.069, P= 0.616) nor between the preoperative and intraoperative changes in HR (r= 0.103, P= 0.453), MAP (r= 0.086, P= 0.535), and NA (r=-0.058, P= 0.674).

CONCLUSION

The results indicated that preoperative pain assessment could predict the level of pain response in OVCF patients during PKP surgery under local anesthesia.

Risk Factors for Severe Pain and Impairment of Daily Life Activities after Cesarean Section-A Prospective Multi-Center Study of 11,932 Patients

Cesarean section (CS) is the most widely performed and one of the most painful surgeries. This study investigated postoperative pain after CS using patient-related outcomes (PROs) to identify risk factors for severe pain. The secondary outcome was to evaluate the influence of surgery indication (primary CS (PCS) vs. urgent CS (UCS)). This multi-center, prospective cohort study included data submitted to the pain registry "quality improvement in postoperative pain treatment" (QUIPS) between 2010 and 2020. In total, 11,932 patients were evaluated. Median of maximal pain was 7.0 (numeric rating scale (NRS) 0 to 10); 53.9% suffered from severe pain (NRS ≥ 7), this being related to impairment of mood, ambulation, deep breathing and sleep, as well as more vertigo, nausea and tiredness (p < 0.001). Distraction, relaxation, mobilization, having conversations, patient-controlled analgesia (PCA) and pain monitoring were shown to be protective for severe pain (p < 0.001). Maximal pain in PCS and UCS was similar, but UCS obtained more analgesics (p < 0.001), and experienced more impairment of ambulation (p < 0.001) and deep breathing (p < 0.05). Severe pain has a major effect on daily-life activities and recovery after CS, and depends on modifiable factors. More effort is needed to improve the quality of care after CS.

Psychiatric Disorders Are Predictive of Worse Pain Severity and Functional Outcomes After Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg

OBJECTIVE

To determine whether concomitant psychiatric diagnoses and medication use were associated with postfasciotomy outcomes in patients with chronic exertional compartment syndrome (CECS).

DESIGN

Retrospective comparative cohort study.

SETTING

Single academic medical center from 2010 to 2020.

PATIENTS

All patients above 18 years old who underwent fasciotomy for CECS.

ASSESSMENT OF RISK FACTORS/INDEPENDENT VARIABLES

Psychiatric history was recorded from electronic health records including disease diagnosis and medications.

MAIN OUTCOME MEASURES

The 3 main outcome measures were postoperative pain using the Visual Analog Scale, functional outcomes using the Tegner Activity Scale, and return to sport.

RESULTS

Eighty one subjects (legs), 54% male, with an average age of 30 years and follow-up of 52 months were included. 24 subjects (30%) had at least one psychiatric diagnosis at the time of surgery. Regression analysis found psychiatric history to be an independent predictor of worse postoperative pain severity and postoperative Tegner scores ( P < 0.05). Furthermore, subjects with psychiatric disorders not on medication had worse pain severity ( P < 0.001) and Tegner scores ( P < 0.01) versus controls, whereas subjects with a psychiatric disorder on medication had better pain severity ( P < 0.05) versus controls.

CONCLUSIONS

History of psychiatric disorder was predictive of worse postoperative pain and activity outcomes after fasciotomy for CECS. Use of psychiatric medication was associated with improvement in pain severity in some domains.

The Impact of Depression in Patients Undergoing Emergency Abdominal Surgery: An Exploratory Study

BACKGROUND

Depression is associated with poorer outcomes in many disease states. However, its significance in abdominal surgery is unknown. This study investigated rates of depression in emergency abdominal surgery patients and its effects on outcomes.

METHODS

A retrospective cohort study was conducted across two UK sites and included all adult patients undergoing emergency abdominal surgery. Primary outcome was the complication rate in depressed patients, including the incidence of post-operative delirium. Secondary outcomes included mortality, time to oral intake and analgesia.

RESULTS

Two hundred and ten patients were identified. The commonest indication for surgery was appendicitis (53.3%) followed by small bowel obstruction (9.5%). There was a 17% (n = 36) incidence of depression amongst patients, most of whom (n = 26, 72.2%) were taking antidepressants. Depression was associated with male sex (M:F 27:9 p = 0.003), higher median BMI (28 vs. 25 p = 0.013) and previous surgery (47.2% vs. 28.7% p = 0.032). Despite a higher incidence of post-operative delirium, increased time to oral analgesia and greater 30-day readmission rates in the depression cohort, multivariate analyses showed depression was not a significant independent predictor of these (OR 2.181, 95%CI 0.310-15.344; p = 0.433, OR 0.07, 95%CI 0.499-1.408; p = 0.348 and OR 1.367, 95%CI 0.102-18.34, respectively). Complication and mortality rates between depressed and non-depressed individuals were similar.

CONCLUSION

Significant numbers of patients undergoing emergency abdominal surgery have depression, but this did not adversely affect post-operative outcomes. The study included relatively small numbers of participants undergoing procedures with straightforward recovery. Larger population studies are therefore required and should focus on investigating the association between major emergency surgeries with post-operative delirium and uncontrolled pain.

[Weight Loss Experience of Highly Obese Young Adult Who Underwent Bariatric Surgery]

PURPOSE

This study aimed to explore the weight loss experience of highly obese young people who underwent bariatric surgery.

METHODS

Data were collected, from October 2021 to April 2022, through individual in-depth interviews with eight highly obese young adults who underwent bariatric surgery and analyzed using Colaizzi's phenomenological method.

RESULTS

The following four theme clusters were extracted. First, 'The unbearable sorrow of obese people' explains the process of choosing bariatric surgery after fluctuations and frustration despite countless repeated weight loss attempts. Second, 'The impact aftermath of bariatric surgery' revealed participants struggling in the face of unexpected changes due to bariatric surgery. Third, 'Efforts to rebuild a healthy myself' demonstrated the struggle to regain health by using the surrounding support system to overcome the difficulties of this surgical procedure. Lastly, 'Facing life by getting rid of the yoke of obesity' displayed the experiences of the participants who felt ambivalent about their changed appearance, but coping positively with the new life.

CONCLUSION

This study provides an in-depth understanding of the weight loss experiences of highly obese adolescents who underwent bariatric surgery and presents a new perspective on clinical practice. The results of this study are expected to be useful in developing and applying systematic and customized nursing interventions before and after bariatric surgery.

Impact of post-discharge phone calls on non-urgent hospital returns < 90 days following primary bariatric surgery

INTRODUCTION

Quality of care delivery may improve patient outcomes post-bariatric surgery. We examined the quality of post-discharge phone calls (Ph_DC) to determine the impact on early (< 90 day) non-urgent hospital returns (NUHR) following primary bariatric surgery.

METHODS

A retrospective review was performed on patients who underwent Roux-en-Y-gastric bypass (RYGB) or sleeve gastrectomy (SG) in 2019. Patients were compared between presence of care coaching (Jan-June 2019) versus no care coaching (July-Dec 2019). Baseline demographics, comorbidities, psychiatric history, and Ph_DC were collected. Index Ph_DCs were coded for completeness using a scoring system and rated by call quality. Patients were stratified into NUHR versus control group (Never returns [NR]). Primary analysis examined the impact of Ph_DC on NUHR. Sub-analysis examined the impact of call quality. Univariate analysis was performed using Chi-square or Fisher's exact tests. Multivariate analysis (MVA) was used to determine predictors of NUHR. A p-value of ≤ 0.05 was statistically significant.

RESULTS

A total of 359 patients were included. Compared to the NR group (n = 294), NUHRs (n = 65) were more likely to be younger (41.3 + 12.1 versus 45.0 + 10.8 years, p = 0.024), with baseline anxiety (41.5% versus 23.5%, p = 0.003), and undergo RYGB (73.3% versus 57.8%, p = 0.031). There was a significant difference in number of Ph_DC in the NUHR and NR groups (p = 0.0206). Care-coached patients had significantly higher rates of high-quality phone calls (p < 0.0001) compared to non-care-coached patients. MVA demonstrated younger age (OR = 0.97, CI: 0.95-1.00; p = 0.023), anxiety (OR = 2.09, CI: 1.17-3.73; p = 0.012), RYGB (OR = 1.88, CI: 1.02-3.45; p = 0.042), and > 50% call quality versus no Ph_DC (OR = 0.45, CI: 0.25-0.83; p = 0.010) were independently associated with NUHRs.

CONCLUSION

High-quality Ph_DCs may play a role in mitigating NUHRs. Care coaching represents a potential intervention to decrease high rates of NUHR in primary bariatric surgery patients.

Analgesic Efficacy of Gabapentin and Pregabalin in Patients Undergoing Laparoscopic Bariatric Surgeries: a Systematic Review and Meta-analysis

This meta-analysis investigated the effect of oral gabapentinoids (i.e., pregabalin and gabapentin) on analgesic consumption (i.e., primary outcome) and pain relief (i.e., secondary outcome) in patients following bariatric surgery. Analysis of five eligible trials published between 2010 and 2019 including 363 participants receiving gabapentinoids revealed a significantly lower morphine consumption [mean difference (MD) =  - 15.1 mg, p = 0.004; evidence certainty: low] and risk of nausea/vomiting [risk ratio (RR) = 0.49, p = 0.002; evidence certainty: high] at postoperative 6-24 h. There was also a lower pain score at postoperative 0-4 h (MD =  - 1.41, p < 0.00001; evidence certainty: low) and 6-12 h (MD =  - 0.9, p = 0.007; evidence certainty: low) compared with controls, while pain severity at postoperative 24 h was comparable between two groups. In summary, preoperative oral gabapentinoids optimized postoperative pain outcomes and reduced risk of nausea/vomiting following bariatric surgery.

Preoperative Anxiety and Postoperative Pain in Patients With Laparoscopic Hysterectomy

Objective: This study was designed to investigate preoperative anxiety situations and postoperative pain degree in Chinese patients undergoing laparoscopic hysterectomy and to analyze the related factors of preoperative anxiety and the correlation between preoperative anxiety and postoperative pain to provide a reference for effective postoperative analgesia management.

Methods: A total of 100 female patients undergoing laparoscopic hysterectomy were enrolled in this study and randomly divided into two groups (n = 50, each). In group A, the patients were treated with dexmedetomidine and sufentanil for postoperative analgesia. In group B, the patients were treated with sufentanil alone for postoperative analgesia. All patients were evaluated with a self-rating anxiety scale (SAS) 1 day before the operation. The patients’ pain was evaluated using the numerical rating scale (NRS) 1 day after the operation, and data were recorded.

Results: In these 100 patients, the highest preoperative SAS score was 48, and the average score was 40.99 ± 4.55 points, which is higher than the norm in China. There were significant differences in preoperative SAS scores among patients with different occupations and previous surgical experience (P < 0.05). There was no significant difference in SAS scores among patients with different education levels (P > 0.05). The postoperative NRS score of group A was significantly higher than that of group B, and the difference was statistically significant (P < 0.05). The correlation coefficients between SAS scores and NRS scores in groups A and B were 0.836 and 0.870, respectively, presenting with a significantly positive correlation.

Conclusion: Preoperative anxiety is an important predictor of postoperative pain. Patients undergoing laparoscopic hysterectomy have preoperative anxiety. The degree of anxiety is influenced by the occupation and previous operation experience of the patients, and patients with higher preoperative anxiety have greater postoperative pain. In addition, we should not neglect the management of postoperative pain because of the small trauma of laparoscopic surgery, and dexmedetomidine combined with sufentanil can improve the postoperative analgesic effect.