Modulating Influence of State Anxiety on the Effect of Midazolam on Postsurgical Pain
Anxiety contributes to postsurgical pain, and midazolam is frequently prescribed preoperatively. Conflicting results have been described concerning the impact of midazolam on pain. This study aims to evaluate the effect of systemic midazolam on pain after open inguinal hernia repair, clarifying its...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/7/2669 |
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| author | Caroline Dahlem Catarina Monteiro Eunice Mendes Joana Martinho Carmen Oliveira Margarida Bettencourt Miguel Coelho Paula Neves Luís Azevedo Cristina Granja |
| author_facet | Caroline Dahlem Catarina Monteiro Eunice Mendes Joana Martinho Carmen Oliveira Margarida Bettencourt Miguel Coelho Paula Neves Luís Azevedo Cristina Granja |
| author_sort | Caroline Dahlem |
| collection | DOAJ |
| description | Anxiety contributes to postsurgical pain, and midazolam is frequently prescribed preoperatively. Conflicting results have been described concerning the impact of midazolam on pain. This study aims to evaluate the effect of systemic midazolam on pain after open inguinal hernia repair, clarifying its relationship with preoperative anxiety. A prospective observational cohort study was conducted in three Portuguese ambulatory units between September 2018 and March 2020. Variable doses of midazolam were administered. Postsurgical pain was evaluated up to three months after surgery. We enrolled 306 patients and analyzed 281 patients. The mean preoperative anxiety Numeric Rating Scale score was 4 (3) and the mean Surgical Fear Questionnaire score was 22 (16); the mean midazolam dose was 1.7 (1.1) mg with no correlation to preoperative anxiety scores. Pain ≥4 was present in 67% of patients 24 h after surgery and in 54% at seven days; at three months, 27% were classified as having chronic postsurgical pain. Preoperative anxiety correlated to pain severity at all time points. In multivariable regression, higher midazolam doses were associated with less pain during the first week, with no apparent effect on chronic pain. However, subgroup analyses uncovered an effect modification according to preoperative anxiety: the decrease in acute pain occurred in the low-anxiety patients with no effect on the high-anxiety group. Inversely, there was an increase in chronic postsurgical pain in the very anxious patients, without any effect on the low-anxiety group. Midazolam, generally used as an anxiolytic, might impact distinctively on pain depending on anxiety. |
| first_indexed | 2024-03-11T05:33:18Z |
| format | Article |
| id | doaj.art-ebde8b6547a54055bb58acb292f426a2 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T05:33:18Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-ebde8b6547a54055bb58acb292f426a22023-11-17T17:00:18ZengMDPI AGJournal of Clinical Medicine2077-03832023-04-01127266910.3390/jcm12072669Modulating Influence of State Anxiety on the Effect of Midazolam on Postsurgical PainCaroline Dahlem0Catarina Monteiro1Eunice Mendes2Joana Martinho3Carmen Oliveira4Margarida Bettencourt5Miguel Coelho6Paula Neves7Luís Azevedo8Cristina Granja9CINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, PortugalDepartment of Anesthesiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, PortugalDepartment of Anesthesiology, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, PortugalDepartment of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, PortugalCINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, PortugalDepartment of Anesthesiology, Centro Hospitalar do Baixo Vouga, EPE, 3810-164 Aveiro, PortugalDepartment of Anesthesiology, Centro Hospitalar do Baixo Vouga, EPE, 3810-164 Aveiro, PortugalDepartment of Anesthesiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, PortugalCINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, PortugalCINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, PortugalAnxiety contributes to postsurgical pain, and midazolam is frequently prescribed preoperatively. Conflicting results have been described concerning the impact of midazolam on pain. This study aims to evaluate the effect of systemic midazolam on pain after open inguinal hernia repair, clarifying its relationship with preoperative anxiety. A prospective observational cohort study was conducted in three Portuguese ambulatory units between September 2018 and March 2020. Variable doses of midazolam were administered. Postsurgical pain was evaluated up to three months after surgery. We enrolled 306 patients and analyzed 281 patients. The mean preoperative anxiety Numeric Rating Scale score was 4 (3) and the mean Surgical Fear Questionnaire score was 22 (16); the mean midazolam dose was 1.7 (1.1) mg with no correlation to preoperative anxiety scores. Pain ≥4 was present in 67% of patients 24 h after surgery and in 54% at seven days; at three months, 27% were classified as having chronic postsurgical pain. Preoperative anxiety correlated to pain severity at all time points. In multivariable regression, higher midazolam doses were associated with less pain during the first week, with no apparent effect on chronic pain. However, subgroup analyses uncovered an effect modification according to preoperative anxiety: the decrease in acute pain occurred in the low-anxiety patients with no effect on the high-anxiety group. Inversely, there was an increase in chronic postsurgical pain in the very anxious patients, without any effect on the low-anxiety group. Midazolam, generally used as an anxiolytic, might impact distinctively on pain depending on anxiety.https://www.mdpi.com/2077-0383/12/7/2669midazolamanxietypostsurgical paininguinal herniaanesthesia |
| spellingShingle | Caroline Dahlem Catarina Monteiro Eunice Mendes Joana Martinho Carmen Oliveira Margarida Bettencourt Miguel Coelho Paula Neves Luís Azevedo Cristina Granja Modulating Influence of State Anxiety on the Effect of Midazolam on Postsurgical Pain Journal of Clinical Medicine midazolam anxiety postsurgical pain inguinal hernia anesthesia |
| title | Modulating Influence of State Anxiety on the Effect of Midazolam on Postsurgical Pain |
| title_full | Modulating Influence of State Anxiety on the Effect of Midazolam on Postsurgical Pain |
| title_fullStr | Modulating Influence of State Anxiety on the Effect of Midazolam on Postsurgical Pain |
| title_full_unstemmed | Modulating Influence of State Anxiety on the Effect of Midazolam on Postsurgical Pain |
| title_short | Modulating Influence of State Anxiety on the Effect of Midazolam on Postsurgical Pain |
| title_sort | modulating influence of state anxiety on the effect of midazolam on postsurgical pain |
| topic | midazolam anxiety postsurgical pain inguinal hernia anesthesia |
| url | https://www.mdpi.com/2077-0383/12/7/2669 |
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