Patryk Eisler

Perioperative anxiety is a multifaceted phenomenon that significantly impacts patients undergoing surgical procedures. Despite advancements in surgical techniques and anesthetic management, the psychological burden associated with anesthesia and surgery remains a significant challenge for healthcare providers. Up to 30% of patients suffer from anesthesia-related preoperative anxiety, irrespective of whether the procedure is elective or emergent. Notably, anxiety can adversely affect patient outcomes, including pain management, patient safety, overall quality of care, and patient satisfaction. Addressing perioperative anxiety requires a comprehensive understanding of its causes, assessment tools, and management strategies to ensure optimal perioperative care. This review examines the historical context, incidence, causes, pathophysiology, assessment tools, and current evidence regarding management strategies for anesthesia-related anxiety, and provides an outlook on future directions for research and everyday practice.

Background. Patients undergoing breast surgery are at risk of severe postoperative pain. Several opioid-sparing strategies exist to alleviate this condition. Regional anesthesia has long been a part of perioperative pain management for these patients. Aim. This randomized study examined the benefits of interpectoral and pectoserratus plane block (IPP/PSP), also known as pectoralis nerve plain block, compared with advanced local anesthetic infiltration. Methods. We analyzed 57 patients undergoing partial mastectomy with sentinel node dissection. They received either an ultrasound-guided IPP/PSP block performed preoperatively by an anesthetist or local anesthetic infiltration performed by the surgeon before and during the surgery. Results. Pain measured with the numerical rating scale (NRS) indicated no statistically significant difference between the groups (IPP/PSP 1.67 vs. infiltration 1.97; value 0.578). Intraoperative use of fentanyl was significantly lower in the IPP/PSP group (0.18 mg vs 0.21 mg; value 0.041). There was no statistically significant difference in the length of stay in the PACU (166 min vs 175 min; value 0.51). There were no differences in reported postoperative nausea and vomiting (PONV) between the groups. The difference in postoperative use of oxycodone in the PACU ( value 0.7) and the use of oxycodone within 24 hours postoperatively ( value 0.87) was not statistically significant. Conclusions. Our study showed decreased intraoperative opioid use in the IPP/PSP group and no difference in postoperative pain scores up to 24 hours. Both groups reported low postoperative pain scores. This trial is registered with NCT04824599.