The effectiveness of perioperative anesthesia during uterine surgery, taking into account the psychoemotional status of patients

Introduction. The leading positions in terms of pain intensity in the postoperative period are occupied by operations in the scope of hysterectomy and myomectomy. The psychological component plays an important role in the formation of postoperative pain.

The objective was to conduct a comparative analysis of the effectiveness of methods of perioperative anesthesia during operations on the uterus with laparotomy access, taking into account the psychoemotional status of patients.

Materials and methods. The study included 50 patients who underwent scheduled hysterectomy from laparotomy access. Depending on the method of perioperative anesthesia, the patients were divided into two groups: group 1 (n = 25) – combined spinal–epidural anesthesia; group 2 (n = 25) – spinal anesthesia with prolonged local anesthesia of the postoperative wound. On the eve of the operation, the level of anxiety and depression, pain catastrophization, and the level of alexithymia were assessed. In the postoperative period, the pain level was assessed according to a digital rating scale: at the time of the first activation, 24 and 48 hours after surgery, and at discharge. The activation time, the need for additional anesthesia, and satisfaction with the received anesthesia were analyzed.

Results. Pain syndrome was significantly higher in the 2nd group – 3 [2; 4] points at rest (p = 0.019) and 4 [3; 5] points during movement (p = 0.04), on the 1st day after surgery. In the 2nd group, more intense pain at the time of the first activation was 5 [3; 5] points (p = 0.001). Patients with identified anxiety/ depression have an increased need for local anesthetics. The preoperative pain catastrophization level of more than 19 points was accompanied by a more pronounced pain syndrome, regardless of the method of anesthesia. Patients who scored ≥ 55 points on the oronto Alexithymia Scale had a higher need for narcotic analgesics.

Conclusion. Combined spinal-epidural anesthesia is more effective in patients with signs of anxiety/depression and alexithymia. Clinically pronounced anxiety and depression according to HADS ≥ 8 points, a score according to PCS ≥ 19 points, as well as a score according to TAS-26 ≥ 55 points make it possible to identify a group at increased risk for the development of uncontrolled pain syndrome and low satisfaction with postoperative anesthesia.

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