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Preoperative Psychologic and Demographic Predictors of Pain Perception and Tramadol Consumption Using Intravenous Patient-controlled Analgesia

De Cosmo, Germano MD*; Congedo, Elisabetta MD*; Lai, Carlo PhD; Primieri, Paolo MD*; Dottarelli, Alessandra MD*; Aceto, Paola MD*

The Clinical Journal of Pain: June 2008 - Volume 24 - Issue 5 - p 399-405
doi: 10.1097/AJP.0b013e3181671a08
Original Articles

Objectives Postoperative pain is characterized by a wide variability of patients' pain perception and analgesic requirement. The study investigated the extent to which demographic and psychologic variables may influence postoperative pain intensity and tramadol consumption using patient-controlled analgesia (PCA) after cholecystectomy.

Methods Eighty patients, aged 18 to 70 years, with an American Society of Anesthesiologists physical status I or II and a body mass index between 18.5 and 24.9, undergoing laparoscopic cholecystectomy were enrolled. Self-rating anxiety scale (SAS) and self-rating questionnaire for depression (SRQ-D) were used—1 day before surgery—to assess patients' psychologic status. General anesthesia was standardized. PCA pump with intravenous tramadol was used for a 24-hour postoperative analgesia. Visual analog scale at rest (VASr) and after coughing (VASi) and tramadol consumption were registered. Pearson's and point biserial correlations, analysis of variance, and step-wise regression were used for statistical analysis.

Results Pearson r showed positive correlations between anxiety, depression, and pain indicators (P<0.05). Moreover, female patients had higher pain indicators (P<0.05). Analysis of variance showed that anxious (P<0.05) and depressed (P<0.001) patients had higher pain indicators, which significantly decreased during the postoperative 24 hours (P<0.00001). Regression analysis revealed that tramadol consumption was predicted by preoperative depression (P<0.001). VASr was predicted by sex and SRQ-D (P<0.05). VASi was predicted by sex and SAS (P<0.05).

Discussion Pain perception intensity was primarily predicted by sex with an additional role of depression and anxiety in determining VASr and VASi, respectively. Patients with high depression levels required a larger amount of tramadol.

*Department of Anaesthesiology and Intensive Care

Psychiatry and Psychology Institute, Policlinico Universitario A. Gemelli, Rome, Italy

Presented as abstract at the 59th National Congress SIAARTI Bari, Ottobre 3 to 6, 2005. Ref. Min Anestesiol. 71(Suppl 2):130.

Reprints: Prof Germano De Cosmo, MD, Department of Anaesthesiology and Intensive Care, Policlinico Universitario A. Gemelli, L.go A. Gemelli 8, Rome 00168, Italy (e-mail:

Received for publication June 1, 2007; revised December 14, 2007; accepted January 3, 2008

© 2008 Lippincott Williams & Wilkins, Inc.