Caregiver anxiety and the association with acute postoperative pain in children undergoing elective ambulatory surgery in a lower-middle-income country setting

Abstract

Background and aims: Moderate to severe postoperative pain complicates surgeries performed on children in upper-income countries. The successful management of postoperative pain in children requires a biopsychosocial approach. Situational anxiety and anxiety disorders among caregivers influence a child's perioperative experience. This study aims to determine whether there is an association between caregiver's preoperative anxiety and children's postoperative pain in a lower-middle-income country (LMIC) setting.

Methods: In this cross-sectional, descriptive study, we recruited 76 children aged 4-12 years, undergoing elective ambulatory tonsillectomy or adenotonsillectomy. Primary caregivers completed validated measures of anxiety (the Beck Anxiety Inventory [BAI] and the Kessler Psychological Distress Scale [K10]) prior to the children undergoing surgery. Postoperative pain was measured using the Wong-Baker Faces Pain Rating Scale 4 hours after surgery.

Results: Caregiver anxiety was found in 31.7% of participants using the K10 and in 42.1% using the BAI. Moderate to severe postoperative pain was reported by 51% of children. There was a statistically significant correlation of moderate strength between anxiety scores of caregivers and children's self-reported postoperative pain scores (r = .47 for K10, r = .44 for BAI, P < .001 for both). Two median quantile regression models confirmed that K10 was positively associated with caregiver anxiety (WBFS) with slope = 0.16 and pseudo R² = 0.25 (P = .002, 95CI: 0.06-0.26) as was BAI with slope = 0.12 and pseudo R² = 0.22 (P = .013 95CI: 0.03-0.22).

Conclusions: This study showed that preoperative caregiver anxiety is significantly associated with postoperative pain in children undergoing elective, ambulatory surgery in a LMIC setting (correlation of moderate strength). Interventions aimed at reducing caregiver anxiety should become an important component of the biopsychosocial management of postoperative pain in children.

Keywords: acute pain; anxiety; child; lower-middle-income country; postoperative pain; surgery.