An Examination of the Impact of Depth of Anaesthesia on Post-Operative Pain Following Wide ...

180 Pages·2013·2.11 MB·English

An Examination of the Impact of Depth of Anaesthesia on Post-Operative Pain
Following Wide Local Excision of Breast Tissue for Breast Cancer
Submitted for the degree of
Doctorate in Clinical Psychology
Peter Beardsworth
Department of Clinical Psychology
University of Leicester
2013
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1 DECLARATION
I, Peter Beardsworth, declare that the research report is my own work and has not been
submitted for any other academic award.
Peter Beardsworth 03/09/2013
Trainee Clinical Psychologist
University of Leicester
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2 ABSTRACT
Literature Review
Despite Mixed findings previous reviews of the literature have highlighted a predictive
relationship between pre-operative psychological variables and post-operative pain
(Hinrichs-Rocker, Schulz, Jarvinen & Lefering, 2009). This review examined the research
published between 2000 and 2013. Eleven studies were identified and discussed. The
review noted evidence that psychological variables specific to aspects of pain, mediated
the effect of other psychological variables, which indicate general mood states, on pain.
Implications for research and clinical practice were also discussed.
Research report
This paper detailed a feasibility study exploring the issues associated with a full scale
project analyzing the link between lightness of anaesthesia and post-operative pain (Law,
Sleigh, Barnard & MacColl, 2011). A prospective, longitudinal repeated measures design
was employed. To control for pre-operative variables the State Trait Anxiety Inventory,
state and trait versions (STAI-Y1 and Y2 respectively), The Magill Pain Questionnaire –
Short Form (MPQ-SF), the Pain Locus of Control Questionnaire (PLOCQ) and a non-
validated body image screening question were administered pre-operatively. Depth of
anaesthesia was measured intra-operatively using a Bispectral Index Monitor (BIS).
Follow up was conducted a 1-2 days, 6 weeks and 3 months post-operatively. At follow up
the MPQ-SF, STAI-Y1 and body image screening question were administered. Twelve
participants were recruited. A statistically significant effect of lightness of anaesthesia on
post-operative pain was not detected due to small sample size. It was concluded that a
large scale study would be feasible. Implications for the execution of future research
projects are discussed, as well as for clinical practice.
Critical Appraisal
The critical appraisal explored personal reflections on the research process. Areas
covered included motivations to carry out the research project, the experience of the
researcher at various stages of the process and discussion of lessons for future
researchers in this area.
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3 ACKNOWLEDGEMENTS
I would like to thank my project supervisor Professor Mike Wang, whose support and help
recruiting local contacts meant that the project could begin, Dr Lesley Colvin, for advice
during the design process, Mr Jarek Kruppa, for advice on operation choice and support
whilst carrying out the research and Christine Power for agreeing to be involved in the
research. Special thanks must go to Dr ‘Libby’ Jonck, without your tireless support and
constant hard work the project would never have been a success. Thank you to all the
staff that I came into contact with on the ward and in the theatre, who were all so helpful,
especially Howard and Y for helping with the BIS monitor. Thanks go to all my family who
have been great, especially my father for proofreading my rough drafts and my mum,
whose support kept me going!
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4 WORD COUNTS
Overall Abstract: 295
Literature Review Abstract: 263
Literature Review: 8,361 (6,796 excluding tables and diagrams)
Thesis Abstract: 299
Main Research Report: 12,517 (11,968 excluding tables)
Critical Appraisal: 4,993
Total Appendices: 8,685
Appendices (Mandatory): 7,619
Appendices (Non-Mandatory): 1,066
Total Word Count for Main Text (Excluding Mandatory Appendices): 26,937
Total Word Count for Main Text (Excluding Tables, References & Appendices): 23,757
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5 TABLE OF CONTENTS
1. Declaration..................................................................................................................2
2. Abstract.......................................................................................................................3
3. Acknowledgements.....................................................................................................4
4. Word counts................................................................................................................5
5. Table of Contents........................................................................................................6
6. List of appendices.......................................................................................................7
7. List of tables................................................................................................................8
8. List of figures...............................................................................................................9
9. Literature review........................................................................................................10
10. Abstract...................................................................................................................11
11. Introduction.............................................................................................................12
12. Method ..................................................................................................................19
13. Results Section......................................................................................................22
14. Discussion .............................................................................................................41
15. References.............................................................................................................53
16.Research report.........................................................................................................59
17. Abstract..................................................................................................................60
18. Introduction.............................................................................................................61
19. Method...................................................................................................................76
20. Results...................................................................................................................87
21. Discussion............................................................................................................106
22. References...........................................................................................................119
23.Critical Appraisal of the Research Process.............................................................127
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6 LIST OF APPENDICES
Appendix A: Position of the Researcher……………………………………………….144
Appendix B: Chronology of the Research Process…………………………………...145
Appendix C: Guidelines……………………………………………………………….....146
Appendix D: Participant Information Sheet and Consent Form……………………..156
Appendix E: Letters from Ethics Committees………………………………………….162
Appendix F: Data Extraction Form……………………………………………………...176
Appendix G: Quality Assessment Tools………………………………………………...177
Appendix H:STROBE and Quality Assessment Checklist Scores…………………...180
Appendix I: Copies of Questionnaires…………………………………………………..183
Appendix J: Scoring Procedures for Questionnaires………………………………….188
Appendix K: Raw Data…………………………………………………………………...191
Appendix L: Descriptive Statistics for the Pain Locus of Control Questionnaire and the
Body Image Question (BIQ)………………………………………………………..........194
Appendix M: Pain Intensity by Depth of Anaesthesia Controlling for Pre-Operative Pain
Intensity SPSS Output……………………………………………………………...........195
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7 LIST OF TABLES
Table 1 Studies excluded ........................................................................................................ 20
Table 2 Studies included ......................................................................................................... 23
Table 3 Anxiety Measures and post-operative pain ................................................................ 33
Table 4 Proportion of anxiety measures correlated with and predictive of post-operative
pain ......................................................................................................................................... 33
Table 5 Depression and post-operative pain .......................................................................... 35
Table 6 Proportion of depression measures correlated with and predictive of post-operative
pain in the short and longer-term …........................................................................................ 35
Table 7 Pain Beliefs and post-operative pain ......................................................................... 37
Table 8 Proportion of pain belief measures correlated with and predictive of post-operative pain
in the short- and longer-term .................................................................................................. 37
Table 9 Illness perceptions and post-operative pain .............................................................. 39
Table 10 Proportion of illness perception measures correlated with and predictive of post-
operative pain in the short- and longer-term ........................................................................... 40
Table 11 Descriptive statistics ................................................................................................. 89
Table 12 BIS scores above 50 ................................................................................................ 91
Table 13 Post-operative pain scores ...................................................................................... 91
Table 14 Mean MPQ-SF scores ............................................................................................ 100
Table 15 Mean Pain Intensity ................................................................................................ 101
Table 16 Mean PPI scores .................................................................................................... 103
Table 17 Pearson’s r correlations .......................................................................................... 104
Table 18 Mean pain scores at 6 weeks and 3 months follow-up ........................................... 106
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8 LIST OF FIGURES
Figure 1 Mediating relationships ...................................................................................... 17
Figure 2 Gate control theory of pain ................................................................................. 66
Figure 3 Mean post-operative MPQ-SF scores by anaesthetic depth .............................. 92
Figure 4 Mean post-operative Pain Intensity scores by anaesthetic depth....................... 93
Figure 5 Mean post-operative PPI scores by anaesthetic depth ............................…...... 94
Figure 6 Scatter plot of pre- and post-operative MPQ scores by anaesthetic depth......... 95
Figure 7 Scatter plot of pre- and post-operative Pain Intensity scores by anaesthetic
depth................................................................................................................................. 96
Figure 8 Scatter plot of pre- and post-operative PPI scores by anaesthetic depth........... 97
Figure 9 Mean MPQ-SF scores pre- and post-operatively by anaesthetic depth …....... 100
Figure 10 Mean pain intensity scores pre- and post-operatively by anaesthetic
depth ............................................................................................................................... 102
Figure 11 Mean MPQ-SF scores pre- and post-operatively by anaesthetic depth …..... 103
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9 LITERATURE REVIEW
THE RELATIONSHIP BETWEEN PRE-OPERATIVE PSYCHOLOGICAL VARIABLES
AND POST-OPERATIVE PAIN
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