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Caregiver anxiety and the association with acute postoperative pain in children undergoing elective ambulatory surgery in a lower‐middle‐income country setting
Author(s) -
Knoetze Reynard,
Lachman Anusha,
Moxley Karis,
Chetty Sean
Publication year - 2020
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.13954
Subject(s) - medicine , beck anxiety inventory , anxiety , tonsillectomy , biopsychosocial model , perioperative , ambulatory , flacc scale , physical therapy , distress , adenoidectomy , anesthesia , postoperative pain , psychiatry , clinical psychology , surgery , beck depression inventory
Background and aims Moderate to severe postoperative pain complicates surgeries performed on children in upper‐income countries. The successful management of postoperative pain in children requires a biopsychosocial approach. Situational anxiety and anxiety disorders among caregivers influence a child's perioperative experience. This study aims to determine whether there is an association between caregiver's preoperative anxiety and children's postoperative pain in a lower‐middle‐income country (LMIC) setting. Methods In this cross‐sectional, descriptive study, we recruited 76 children aged 4‐12 years, undergoing elective ambulatory tonsillectomy or adenotonsillectomy. Primary caregivers completed validated measures of anxiety (the Beck Anxiety Inventory [BAI] and the Kessler Psychological Distress Scale [K10]) prior to the children undergoing surgery. Postoperative pain was measured using the Wong‐Baker Faces Pain Rating Scale 4 hours after surgery. Results Caregiver anxiety was found in 31.7% of participants using the K10 and in 42.1% using the BAI. Moderate to severe postoperative pain was reported by 51% of children. There was a statistically significant correlation of moderate strength between anxiety scores of caregivers and children's self‐reported postoperative pain scores ( r = .47 for K10, r = .44 for BAI, P < .001 for both). Two median quantile regression models confirmed that K10 was positively associated with caregiver anxiety (WBFS) with slope = 0.16 and pseudo R 2 = 0.25 ( P = .002, 95CI: 0.06‐0.26) as was BAI with slope = 0.12 and pseudo R 2 = 0.22 ( P = .013 95CI: 0.03‐0.22). Conclusions This study showed that preoperative caregiver anxiety is significantly associated with postoperative pain in children undergoing elective, ambulatory surgery in a LMIC setting (correlation of moderate strength). Interventions aimed at reducing caregiver anxiety should become an important component of the biopsychosocial management of postoperative pain in children.