• adolescents;
  • anxiety;
  • children;
  • elective surgical procedure;
  • nursing;
  • pain;
  • perioperative;
  • postoperative;
  • surgery;
  • systematic review



To examine the relationship between perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures and the differences in children's perioperative anxiety and postoperative pain among subgroups of demographics.


While anxiety and pain are regarded as two common problems experienced by children and adolescents perioperatively and the relationship between them has been reported in previous studies, there has been no review paper examining this phenomenon.


A quantitative systematic review.

Data sources

Nine electronic databases were searched for studies published in English from the inception date of the databases to December 2010, using various combinations of search terms of ‘adolescents', ‘anxiety’, ‘child’, ‘pain’, ‘surgery’ and ‘correlation/relationship’.

Review methods

Using the Joanna Briggs Institute's comprehensive systematic review strategies, relevant studies were independently appraised and extracted by two reviewers using the standardized critical appraisal instruments and data extraction tool from Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument.


Ten studies were included in this review from 943 studies initially retrieved. Children and adolescents who had higher level of perioperative anxiety experienced a higher level of postoperative pain. Inconclusive evidence was found regarding differences of perioperative anxiety and postoperative pain between demographic subgroups of gender, age and past surgical experience.


Results of this review inform healthcare providers of the role perioperative anxiety plays on children's and adolescents' postoperative pain and indicate the need to use interventions to reduce perioperative anxiety and, therefore, optimize their postoperative pain management during the perioperative period.