The Effect of Affective Temperament on Block Success and Hemodynamics in Patients Undergoing Axillary Plexus Block for Distal Radius Fracture: A Prospective Observational Study.
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 46
- 试验地点
- 1
- 主要终点
- Anesthesia Escalation (Sedation and/or General Anesthesia)
研究概览
简要总结
This study looked at whether a person's emotional personality type affects how they experience pain and how well a regional anesthesia technique works during arm surgery.
We studied patients who underwent wrist or upper arm surgery using an axillary nerve block (a type of regional anesthesia that numbs the arm). Before surgery, patients completed a questionnaire measuring their emotional temperament, including anxious, depressive, cyclothymic, irritable, and other personality traits.
We found that patients with an anxious personality type were more likely to need conversion to general anesthesia during surgery. They also reported higher pain scores after surgery. Patients with depressive traits also experienced higher pain levels. In contrast, some other temperament types reported lower pain levels.
These findings suggest that emotional characteristics may influence how patients respond to anesthesia and pain after surgery. Understanding a patient's temperament before surgery may help doctors better plan anesthesia, provide additional support when needed, and improve overall comfort and safety.
This research supports a more personalized approach to anesthesia care, taking into account not only physical health but also psychological factors.
详细描述
This prospective observational study evaluates the association between affective temperament profiles and perioperative anesthetic outcomes in adult patients undergoing elective upper extremity surgery under ultrasound-guided axillary brachial plexus block.
Affective temperament was assessed preoperatively using the validated TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris, and San Diego - Autoquestionnaire). Based on established scoring methodology, participants were categorized into depressive, anxious, cyclothymic, hyperthymic, irritable, or non-dominant temperament types. The instrument is grounded in Akiskal's affective temperament model, which conceptualizes temperament as a stable trait influencing stress reactivity, emotional processing, and physiological responses.
All patients received a standardized anesthetic protocol. Ultrasound-guided axillary brachial plexus block was performed with identification of the radial, median, ulnar, and musculocutaneous nerves. A total of 20 mL of 0.25% bupivacaine was administered. Intravenous fentanyl (50 µg) was given prior to block placement. Intraoperative discomfort was managed with supplemental sedation. Conversion to general anesthesia was performed when regional anesthesia alone was insufficient to maintain surgical conditions. Block failure was defined as inability to complete the procedure using the regional technique alone.
Hemodynamic parameters (systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate) were recorded at baseline and at 5-minute intervals during surgery. Postoperative pain intensity was measured using the Visual Analog Scale at predefined perioperative time points.
Statistical analyses included correlation testing and multivariable modeling. LASSO regression was applied for variable selection and identification of predictors of increased postoperative pain scores. Ridge logistic regression was used to determine independent predictors of anesthesia escalation, accounting for multicollinearity among baseline hemodynamic variables and temperament types.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age between 18 and 65 years
- •Scheduled for elective upper extremity surgery requiring axillary brachial plexus block
- •American Society of Anesthesiologists (ASA) physical status I-III
- •Ability to understand and complete the TEMPS-A questionnaire
- •Provision of written informed consent
排除标准
- •Refusal to participate
- •Contraindication to regional anesthesia (e.g., local infection at injection site, coagulopathy)
- •Known allergy to local anesthetics (bupivacaine)
- •Cognitive impairment or inability to complete the temperament questionnaire
- •Severe psychiatric disorder requiring active treatment
- •Incomplete perioperative data or missing VAS assessments
研究组 & 干预措施
Depressive Temperament Group
Patients classified as having a depressive affective temperament based on TEMPS-A questionnaire scoring.
Procedure: Axillary Brachial Plexus Block
Ultrasound-guided axillary brachial plexus block performed using 20 mL of 0.25% bupivacaine for surgical anesthesia of the upper extremity.
Drug: Intravenous Sedation
Supplemental intravenous sedation administered intraoperatively in cases of patient discomfort during regional anesthesia. Sedation was provided according to standard institutional practice.
Procedure: General Anesthesia (if required)
Conversion to general anesthesia when regional anesthesia with or without sedation was insufficient to maintain adequate surgical conditions. Block failure was defined as inability to complete the procedure under regional anesthesia alone.
Anxious Temperament Group
Patients classified as having an anxious affective temperament according to TEMPS-A assessment.
Procedure: Axillary Brachial Plexus Block
Ultrasound-guided axillary brachial plexus block performed using 20 mL of 0.25% bupivacaine for surgical anesthesia of the upper extremity.
Drug: Intravenous Sedation
Supplemental intravenous sedation administered intraoperatively in cases of patient discomfort during regional anesthesia. Sedation was provided according to standard institutional practice.
Procedure: General Anesthesia (if required)
Conversion to general anesthesia when regional anesthesia with or without sedation was insufficient to maintain adequate surgical conditions. Block failure was defined as inability to complete the procedure under regional anesthesia alone.
Cyclothymic Temperament Group
Patients identified with cyclothymic temperament characteristics using TEMPS-A.
Procedure: Axillary Brachial Plexus Block
Ultrasound-guided axillary brachial plexus block performed using 20 mL of 0.25% bupivacaine for surgical anesthesia of the upper extremity.
Drug: Intravenous Sedation
Supplemental intravenous sedation administered intraoperatively in cases of patient discomfort during regional anesthesia. Sedation was provided according to standard institutional practice.
Procedure: General Anesthesia (if required)
Conversion to general anesthesia when regional anesthesia with or without sedation was insufficient to maintain adequate surgical conditions. Block failure was defined as inability to complete the procedure under regional anesthesia alone.
Hyperthymic Temperament Group
Patients classified as hyperthymic temperament type based on questionnaire results.
Procedure: Axillary Brachial Plexus Block
Ultrasound-guided axillary brachial plexus block performed using 20 mL of 0.25% bupivacaine for surgical anesthesia of the upper extremity.
Drug: Intravenous Sedation
Supplemental intravenous sedation administered intraoperatively in cases of patient discomfort during regional anesthesia. Sedation was provided according to standard institutional practice.
Procedure: General Anesthesia (if required)
Conversion to general anesthesia when regional anesthesia with or without sedation was insufficient to maintain adequate surgical conditions. Block failure was defined as inability to complete the procedure under regional anesthesia alone.
Irritable Temperament Group
Patients identified as having irritable temperament features according to TEMPS-A scoring.
Procedure: Axillary Brachial Plexus Block
Ultrasound-guided axillary brachial plexus block performed using 20 mL of 0.25% bupivacaine for surgical anesthesia of the upper extremity.
Drug: Intravenous Sedation
Supplemental intravenous sedation administered intraoperatively in cases of patient discomfort during regional anesthesia. Sedation was provided according to standard institutional practice.
Procedure: General Anesthesia (if required)
Conversion to general anesthesia when regional anesthesia with or without sedation was insufficient to maintain adequate surgical conditions. Block failure was defined as inability to complete the procedure under regional anesthesia alone.
Non-Dominant Temperament Group
Patients who did not demonstrate dominance in any of the five primary temperament categories.
Procedure: Axillary Brachial Plexus Block
Ultrasound-guided axillary brachial plexus block performed using 20 mL of 0.25% bupivacaine for surgical anesthesia of the upper extremity.
Drug: Intravenous Sedation
Supplemental intravenous sedation administered intraoperatively in cases of patient discomfort during regional anesthesia. Sedation was provided according to standard institutional practice.
Procedure: General Anesthesia (if required)
Conversion to general anesthesia when regional anesthesia with or without sedation was insufficient to maintain adequate surgical conditions. Block failure was defined as inability to complete the procedure under regional anesthesia alone.
结局指标
主要结局
Anesthesia Escalation (Sedation and/or General Anesthesia)
时间窗: Intraoperative period (from block performance until completion of surgery)
Proportion of patients who required escalation beyond axillary brachial plexus block, defined as the need for additional intravenous sedation and/or conversion to general anesthesia due to inadequate surgical anesthesia or patient discomfort.
次要结局
- Postoperative Pain Intensity (VAS Score)(Preoperative baseline, postoperative 3rd hour, 12th hour, and 24th hour)
- Predictors of Anesthesia Escalation(Intraoperative period)
研究者
Fatma Nur Arslan
Asssistant Professor
Kirsehir Ahi Evran Universitesi