Preoperative anxiety may increase postcesarean delivery pain and analgesic consumption

The aim of this study was to reveal the relationship between high level of prenatal anxiety and postoperative pain and/or analgesic consumption in women undergoing elective cesarean delivery under spinal anesthesia.

Eighty women, aged between 18-45 years with minimum 37 week- gestation and received spinal anesthesia during elective cesarean delivery, were included into this observational cohort study. Prenatal anxiety was measured with state anxiety inventory, trait anxiety inventory and somatosensory amplification scale. Visual Analogue Scale (VAS) was used to quantify postoperative pain. Amount of analgesic consumed was recorded at 6th, 12th and 18th postoperative hours.

State Anxiety Score was above the threshold level (>45) in 18 women (22.5%). No difference was found between women with and without high state anxiety scores except for significantly higher BMI values in high-score group (P=0.07). In multivariate analysis, high BMI at pregnancy (OR: 1.2, 95% CI; 1.0-1.5, P=0.02) and high State Anxiety Score (OR: 1.1, 95% CI; 1.0-1.2, P=0.01) emerged as independent predictors of higher mean pain scores (VAS >4 cm) within 18 hours after cesarean delivery. Also, high State Anxiety Score was found to be independently associated with higher pethidine consumption after cesarean delivery (OR: 1.1, 95% CI; 1.0-1.2, P=0.006).

State anxiety has a negative effect on postcesarean pain whereas trait anxiety does not seem to produce such effect. The effect seems to be more profound in overweight women. Detection of anxiety level before elective cesarean delivery and therapeutic approach to pregnant women may be useful for postoperative pain control.