Effect of Preoperative Anxiety on Postoperative Pain and Analgesic Requirements in Patients Undergoing Elective Surgery: A Prospective Cohort Study

Preoperative anxiety is common before elective surgery but is often assessed informally and seldom incorporated into postoperative analgesic planning. This study evaluated the association between preoperative anxiety, early postoperative pain intensity, and 24-h rescue analgesic requirement.

This prospective cohort study included 56 adult patients with American Society of Anesthesiologists physical status I-III undergoing elective surgery under general or regional anesthesia at a tertiary care hospital. Preoperative state anxiety was assessed using the State-Trait Anxiety Inventory-State scale. Patients with scores >44 were categorized as the High Anxiety group, while those with scores ≤44 formed the Low Anxiety group. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 2, 4, 6, 12, and 24 h. Time to first rescue analgesia and number of rescue analgesic doses during the first 24 h were recorded.

Baseline demographic and perioperative characteristics were comparable between groups. The high anxiety group had higher VAS scores at 2 h (4.1 ± 1.7 vs. 2.6 ± 1.3; P = 0.018) and 4 h (4.5 ± 1.6 vs. 3.8 ± 1.7; P = 0.041). Repeated-measures analysis showed a significant group-by-time interaction (F = 3.42; P = 0.032). Rescue analgesia was required earlier in high-anxiety patients (median 4 vs. 6 h; P = 0.008), and more patients required ≥2 rescue doses within 24 h (46.4% vs. 25.0%; odds ratio: 2.6; P = 0.028).

Higher preoperative anxiety was associated with greater early postoperative pain and increased rescue analgesic need. Brief anxiety screening can support individualized perioperative counseling and closer pain monitoring.