Comparison of Three Benzodiazepines for Oral Premedication in Minor Gynaecological Surgery

Male, C.G.; Lim, Yeen; Male, Musa; Stewart, J. M.; Gibbs, J. M.

doi:10.1093/bja/52.4.429

Cited by 22 publications

(17 citation statements)

References 12 publications

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“…Therefore, investigations on strategies to reduce preoperative anxiety deserve further investigation. Although some studies have demonstrated that BZDs are effective in reducing anxiety before surgery [30,35], these drugs are not a substitute for enhancement of coping skills and increased knowledge with regard to the peri-operative course.…”

mentioning

confidence: 99%

Effect of pre‐operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy

Caumo¹,

Hidalgo²,

Schmidt

et al. 2002

Anaesthesia

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SummaryIn a double blind, placebo-controlled trial, we have assessed the effects of pre-operative anxiolysis on postoperative pain scores in 112 ASA I-II women, aged 18-65 years, scheduled to undergo total abdominal hysterectomy. Subjects were randomly allocated to receive either oral diazepam 10 mg (n ¼ 56) or placebo (n ¼ 56) pre-operatively. Postoperative anxiety, pain scores, analgesic consumption, and sedation were evaluated at several time points during the first 24 h following surgery. Postoperative pain scores were found to be significantly higher in the diazepam group. Trait and state anxiety showed a significant effect on pain scores, independent of the treatment group. No difference was found between the groups in morphine consumption, but there was a significant reduction in morphine consumption with time. The association between anxiety and postoperative pain is well known [1][2][3], and despite the routine use of benzodiazepines (BZD), there is little clinical evidence available on the effects of premedication on postoperative outcomes such as pain scores and analgesic consumption. The effect of premedication has been mainly assessed in relation to: heart rate; blood pressure; neuroendocrine changes; quality of induction of anaesthesia; amnesia and anxiety [4]. It is important that we are aware of the impact that pre-operative anxiety may have on postoperative outcomes [5].The relationship between pre-operative anxiety and postoperative pain is of particular importance, since several pharmacological and non-pharmacological options are available to treat pre-operative anxiety [6]. If increased pre-operative anxiety is associated with increased postoperative pain, then reducing pre-operative anxiety, could reduce postoperative pain.Therefore, the purpose of this study was to assess the effect of pre-operative anxiolysis on postoperative pain scores based on analgesic consumption and pain scores in patients undergoing total abdominal hysterectomy. Methods

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mentioning

confidence: 99%

Effect of pre‐operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy

Caumo¹,

Hidalgo²,

Schmidt

et al. 2002

Anaesthesia

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“…All drugs tested are claimed to be fairly fast absorbed after oral intake and about an hour is a common time lapse in similar previous research studies (8)(9)(10). There are a number of other studies that have been unable to show any major effects of small doses of oral benzodiazepines as compared to placebo (8)(9)(10)(11)(12)(13)(14). In larger doses an anxiolytic effect has been proven but at the risk for a prolonged sedative effect and recovery time (12,14,15).…”

Section: Discussionmentioning

confidence: 85%

“…In larger doses an anxiolytic effect has been proven but at the risk for a prolonged sedative effect and recovery time (12,14,15). In two previous studies of lorazepam 2.5 or 5 mg, pronounced sedative effects were seen within one hour but still only marginal anxiolytic effect (10,13). There are also others who have failed to find any significant differences as regards anxiolysis between intramuscular premedication with other active drugs and placebo (16)(17)(18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

Oral premedication one hour before minor gynaecological surgery — does it have any effect?

Jakobsson

Rane

Ryberg

1995

Acta Anaesthesiol Scand

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The purpose of the present study was to compare the effects of oral premedication with ketobemidone 5 mg, lorazepam 1 mg, propranolol 40 mg or placebo, given about an hour prior to anaesthesia, in a prospective randomized double-blind fashion. One hundred and twenty ASA I female patients scheduled for elective laparoscopy were randomly prescribed one of the study drugs. Patient evaluation of anxiety, nurse evaluation of premedication, induction and postoperative course were studied. Ninety-three of the 120 patients (78%) experienced no change or a decrease in anxiety, regardless of type of active drug or placebo administered. Eighty-eight of the patients (73%) were considered adequately premedicated by the nurse observer, with no differences between the groups. Pre induction pulse rate, blood pressure and amount of induction agent needed was also similar between the four groups of patients. No major differences could be seen during the postoperative course. We found no major effects of any of the active drugs studied compared to placebo. Routine use of small doses of oral premedication one hour before elective surgery among low anxiety patients could probably be omitted.

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“…The hypnotic effect of flunitrazepam the night prior to surgery has been confirmed in earlier studies (5-9). Other investigators have found oxazepam (10-13) and flunitrazepam (9, 10, [14][15][16][17][18][19] useful as prernedication. Pakkanen et al (10) studied the hypnotic, sedative, cardiovascular and unwanted effects in a comparison between oxazepam 30 mg and flunitrazepam 1 mg.…”

Section: Discussionmentioning

confidence: 99%

Benzodiazepines as oral premedication. A comparison between oxazepam, flunitrazepam and placebo

Hofstad

Haavik

Wickstrøm

et al. 1987

Acta Anaesthesiol Scand

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Oxazepam 25 mg, flunitrazepam 1 mg and placebo were compared as oral premedication in 602 gynecological patients in a double-blind randomised parallel study. In 251 patients undergoing major surgery the same drug was also given as a hypnotic the night before the operation. Both active drugs shortened the sleep-onset time, decreased the number of spontaneous awakenings at night and improved the quality of sleep when compared to placebo. The active drugs were significantly better than placebo as premedication when assessed by both the patients and the anesthesiologist. In 351 patients admitted for day-case minor surgery with no previous night medication, flunitrazepam was significantly better than placebo as premedication when assessed by both the patients and the anesthesiologist, while oxazepam was only better than placebo when judged by the anesthesiologist, not by the patients.

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Comparison of Three Benzodiazepines for Oral Premedication in Minor Gynaecological Surgery

Cited by 22 publications

References 12 publications

Effect of pre‐operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy

Effect of pre‐operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy

Oral premedication one hour before minor gynaecological surgery — does it have any effect?

Benzodiazepines as oral premedication. A comparison between oxazepam, flunitrazepam and placebo

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