| Despite the availability and widespread use of effective pain-relieving drugs, many surgical patients remain uncomfortable after surgery. Surgical patients are typically anxious both before and after surgery, which might exacerbate postoperative pain and discomfort, and impede recovery. There is accumulating evidence that postoperative anxiety is related to postoperative pain and negative outcomes such as increased analgesic consumption and longer duration of hospital stay after surgery. Therefore, the reduction of postoperative anxiety might be beneficial to patients, although causality remains undetermined. Furthermore, little is known about positive affective states around the surgery experience.; This study sought to improve postoperative comfort by providing a patient-controlled anxiolytic agent, midazolam, in addition to morphine after surgery. Participants were 29 patients undergoing elective spinal surgery at a southeastern community hospital. Patients were randomly assigned to treatment group (morphine + midazolam) or control group (morphine + placebo). Psychological measures and salivary cortisol were collected at several points before and after surgery. The double-blind, placebo-controlled trial of patient-controlled midazolam revealed that anxiety level in the treatment group declined more rapidly over the 24 hours after surgery than it did in the control group. Although there were no group differences on pain report, the treatment group used less narcotic medication while using the patient-controlled pumps than did the control group. Finally, preoperative positive affect was the only significant psychological predictor of postoperative outcomes, a notable finding since only negative affective states are typically measured throughout the surgical experience. In conclusion, while the addition of midazolam appeared to have no effect on postoperative pain, patients receiving both midazolam and morphine experienced more rapid decline in anxiety and used less narcotic medication than those receiving morphine alone. |
