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From the Departments of Psychological Medicine and Psychotherapy (S.D., F.K., G.R., S.R., B.H., D.S.S., G.S.), Orthopedics (H. Behensky, M.K.), and Anesthesia and General Intensive Care (G.L, P.I., H. Benzer), and the Neurochemical Research Unit, Department of Psychiatry (A.S.), University of Innsbruck, Innsbruck, Austria.
Address reprint requests to: Stephan Doering, MD, Department of Psychological Medicine and Psychotherapy, Sonnenburgstr. 9, A-6020 Innsbruck, Austria. Email: Stephan.Doering{at}uibk.ac.at
OBJECTIVE: Elective surgery represents a considerable source of stress for the patient. Many attempts have been made to prepare patients before surgery with the aim of reducing stress and improving outcome. This study used a novel approach to fulfill this aim by showing a videotape of a patient undergoing total hip replacement surgery, covering the time period from hospital admission to discharge, that strictly keeps to the patient’s perspective.
METHODS: Before elective total hip replacement surgery, 100 patients were randomly assigned to a control group or a preparation group; the latter group was shown the videotape on the evening before surgery. Anxiety and pain were evaluated daily for 5 days, beginning with the preoperative day, by means of the State-Trait Anxiety Inventory and a visual analog scale. Intraoperative heart rate and blood pressure, as well as postoperative intake of analgesics and sedatives, were recorded. Urinary levels of cortisol, epinephrine, and norepinephrine were determined in 12-hour samples collected at night for 5 nights, beginning with the preoperative night.
RESULTS: Compared with the control group, the preparation group showed significantly less anxiety on the morning before surgery and the mornings of the first 2 postoperative days, and significantly fewer of them had an intraoperative systolic blood pressure increase of more than 15%. The pain ratings did not differ significantly between the two groups, but the prepared patients needed less analgesic medication after surgery. Prepared patients had significantly lower cortisol excretion during the preoperative night and the first 2 postoperative nights. Excretion of catecholamines did not differ significantly between groups.
CONCLUSIONS: We conclude that use of the videotape decreased anxiety and stress, measured in terms of urinary cortisol excretion and intraoperative systolic blood pressure increase, in patients undergoing hip replacement surgery and prepared them to cope better with postoperative pain.
Key Words: surgery • preparation • videotape • anxiety • cortisol • catecholamines
Abbreviations: ANOVA = analysis of variance; HPA =hypothalamus-pituitary-adrenal (axis); SBP = systolic bloodpressure; STAI = State-Trait Anxiety Inventory.
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