Prior to undergoing a surgical procedure, many patients are prescribed sedatives to help reduce stress and anxiety before and after surgery. But a new study published in JAMA has questioned the benefits of these sedatives after finding they may not improve patients’ experience and may even do more harm than good.
However, the study researchers – including Dr. Axel Maurice-Szamburski of the Hôpital de la Timone Adulte in Marseille, France – note that benzodiazepines have been associated with a number of side effects, including drowsiness, insomnia and cognitive impairment.
While benzodiazepines are deemed effective for reducing anxiety, the researchers note there is insufficient evidence to conclude their use leads to a better perioperative experience for patients.
“Before antianxiety treatment is administered, patients should be provided the best information about its efficacy,” they add. “More needs to be known about the efficacy of preoperative anxiety treatment to better counsel patients to make informed decisions.”
For their study, Dr. Maurice-Szamburski and colleagues enrolled 1,062 patients under the age of 70 who were due to undergo various elective surgeries under general anesthetic.
The researchers randomly assigned the patients to one of three groups: pre-medication with 2.5 mg of lorazepam – a type of benzodiazepine – 2 hours prior to surgery, a placebo or no pre-medication.
The researchers gauged the patients’ perioperative experience with a questionnaire that was completed within 24 hours of surgery. Patients’ cognitive function was assessed 40 minutes after surgery and incidence of amnesia was assessed the day after surgery.
Compared with patients who received no pre-medication or a placebo, the researchers found that those who received pre-medication with lorazepam experienced no improvement in patient satisfaction. Even among the most anxious patients, the team says there were no significant differences in patient satisfaction between the three groups.
In fact, the researchers found patients who received lorazepam waited much longer to have their breathing tube removed following surgery, compared with those who received no pre-medication or the placebo.
In addition, patients pre-medicated with lorazepam scored much lower on cognitive function than the other two groups and had higher incidence of amnesia.
The researchers note that in their study, only 24% of patients showed very high levels of anxiety. While lorazepam was shown to reduce anxiety prior to surgery, the team says the findings suggest there is “little justification for routine administration of preoperative anxiolytic medication for all surgical patients.”
The authors add:
“Because there was no overall benefit from preoperative anxiety treatment, it is possible that anxiety arising upon arrival to the operating room does not influence overall patient satisfaction.
The findings suggest a lack of benefit with routine use of lorazepam as sedative pre-medication in patients undergoing general anesthesia.”
The researchers note that one limitation of their study is that they only assessed one sedative – results may differ with other sedatives.
Last month, Medical News Today reported on a UK study that suggested distraction techniques during conscious surgery – such as watching a DVD – may be effective for reducing patients’ pain and anxiety throughout the procedure.