Emergency Surgical Procedures, Postoperative Anxiety, Postoperative Pain
Conditions
Keywords
Progressive Relaxation, Emergency Surgery, Postoperative Pain, Anxiety, Physiological Parameters
Brief summary
This randomized controlled trial investigated the effectiveness of postoperative progressive relaxation exercises (PRE) on pain, anxiety, and physiological parameters among adult patients undergoing emergency general surgery. Seventy patients were randomized to either a PRE intervention delivered at postoperative hour 6, postoperative day 1, and postoperative day 2, or to routine postoperative care. Pain (SF-MPQ), anxiety (STAI), and vital signs were measured. The trial demonstrated that PRE significantly reduced multidimensional pain and anxiety and improved heart rate, respiratory rate, and oxygen saturation. The study provides novel evidence that PRE is feasible and effective when implemented exclusively in the postoperative period among emergency surgical patients.
Detailed description
This randomized, parallel-group clinical trial was conducted to evaluate the effectiveness and feasibility of postoperative progressive relaxation exercises (PRE) among patients undergoing emergency general surgery. Emergency surgical admissions provide no opportunity for preoperative preparation, and postoperative pain, anxiety, and autonomic instability are commonly intensified by acute physiological stress responses. The trial was designed to determine whether PRE, delivered exclusively after surgery, could reduce these symptoms and support early physiological recovery. Following confirmation of postoperative stability at hour 6, eligible patients were randomly assigned in a 1:1 ratio to either the PRE intervention or routine postoperative care. The intervention consisted of standardized 30-minute sessions of progressive muscle relaxation conducted at postoperative hour 6, postoperative day 1, and postoperative day 2. Sessions followed a structured protocol including diaphragmatic breathing, sequential contraction-relaxation of major muscle groups, and a final integration phase. All sessions were delivered by a nurse trained in PRE. Outcome assessments were conducted at prespecified time points using validated measures. Pain was evaluated with the Short-Form McGill Pain Questionnaire, anxiety with the State-Trait Anxiety Inventory, and physiological status through routine clinical monitoring of blood pressure, heart rate, respiratory rate, and oxygen saturation. Analyses examined both between-group differences and changes over time. The study adhered to CONSORT guidelines for randomized trials and incorporated blinded outcome assessment and concealed allocation. No adverse events related to the intervention were reported, and all randomized participants completed follow-up.
Interventions
BEHAVIORALProgressive Relaxation Exercises (PRE)
This intervention consists of structured Progressive Relaxation Exercises (PRE) delivered exclusively in the postoperative period. PRE involves diaphragmatic breathing, awareness of muscle tension, and sequential contraction-relaxation of major muscle groups (hands, arms, shoulders, neck, chest, abdomen, back, hips, legs, and feet). Each session lasts 30 minutes and is administered at the bedside by a nurse trained in PRE. The protocol includes a preparation phase (2-3 min), a muscle relaxation sequence (20-22 min), and an integration phase (3-5 min). PRE is delivered at postoperative hour 6, postoperative day 1, and postoperative day 2, in addition to routine care, and does not include any pharmacological components
Sponsors
Agri Ibrahim Cecen University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
Outcome assessors who collected pain, anxiety, and physiological measurements were masked to group assignment throughout the study. Data analysts were also blinded by using coded datasets without group identifiers. Participants and care providers could not be masked due to the behavioral nature of the intervention, but standard postoperative care protocols were applied equally to minimize performance bias.
Intervention model description
The study used simple computer-generated randomization to allocate participants in a 1:1 ratio to the intervention or control arm. Participants remained in their assigned arm throughout the study.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Adults aged 18 years or older. 2. Undergoing an emergency surgical procedure requiring postoperative hospitalization. 3. Conscious, oriented, and hemodynamically stable by postoperative hour 6. 4. Able to communicate and follow verbal instructions. 5. No psychiatric, neurological, cognitive, or auditory impairment that would prevent participation. 6. No chronic pain disorder and not using long-term opioids, sedatives, or anxiolytics before admission. 7. Provided written informed consent.
Exclusion criteria
1. Postoperative admission to the intensive care unit (ICU). 2. Development of postoperative complications preventing participation (e.g., severe bleeding, respiratory distress, infection). 3. Inability to complete all three scheduled PRE sessions. 4. Postoperative confusion, delirium, or any condition limiting communication.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in State Anxiety Score (STAI-State, TX-L1) | Postoperative hour 6 and postoperative day 2. | SSituational anxiety will be assessed using the State Anxiety Inventory (STAI-State). Score Range: 20 to 80. Higher scores indicate greater state anxiety. |
| Change in Postoperative Pain Score (SF-MPQ Total Score) | Postoperative hour 6 and postoperative day 2. | Postoperative pain will be assessed using the Short-Form McGill Pain Questionnaire (SF-MPQ), which includes sensory and affective descriptors, the Present Pain Intensity (PPI) index, and a Visual Analogue Scale (VAS). Total Score Range: 0 to 45. Higher scores indicate greater pain severity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Diastolic Blood Pressure | Postoperative hour 6, postoperative day 1, and postoperative day 2. | Diastolic blood pressure will be measured using a calibrated sphygmomanometer after 10 minutes of rest. |
| Change in Heart Rate | Postoperative hour 6, postoperative day 1, and postoperative day 2. | Heart rate will be measured using bedside monitoring after 10 minutes of rest. |
| Change in Respiratory Rate | Postoperative hour 6, postoperative day 1, and postoperative day 2. | Respiratory rate will be measured using standard clinical monitoring after 10 minutes of rest. |
| Change in Trait Anxiety Score (STAI-Trait, TX-L2) | Postoperative hour 6 and postoperative day 2. | Trait anxiety will be assessed using the STAI-Trait Inventory. Score Range: 20 to 80. Higher scores indicate greater trait anxiety. |
| Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) | Postoperative hour 6, postoperative day 1, and postoperative day 2. | NSAID use will be recorded at each postoperative assessment based on medication administration records. Higher values indicate greater NSAID consumption. |
| Use of Opioid Analgesics | Postoperative hour 6, postoperative day 1, and postoperative day 2. | Opioid analgesic use will be recorded at each postoperative assessment based on medication administration records. Higher values indicate greater opioid consumption. |
| Change in Oxygen Saturation (SpO₂) | Postoperative hour 6, postoperative day 1, and postoperative day 2. | Peripheral oxygen saturation will be measured using pulse oximetry. Higher values indicate better oxygenation. |
| Change in Systolic Blood Pressure | Postoperative hour 6, postoperative day 1, postoperative day 2. | Systolic blood pressure will be measured using a calibrated sphygmomanometer after 10 minutes of rest. Higher values indicate higher systolic blood pressure. |
Countries
Turkey (Türkiye)
Outcome results
None listed