The Impact of Premedication Protocols on Preoperative Anxiety, Intra- and Postoperative Pain, and Anxiety in Blepharoplasty

Abstract

Introduction: Upper eyelid blepharoplasty is the second most popular cosmetic surgical procedure among women and men. Eyelid surgeries are routinely performed under local anesthesia to save operation time, prevent systemic risks associated with general anesthesia and provide faster recovery. To improve patient experience in blepharoplasty various combinations of premedication can be used. Premedication for blepharoplasty consists of medications such as sedatives, anxiolytics, and analgesics that are administered prior to the surgery to help relax the patient, reduce anxiety, and manage any potential discomfort during the procedure. The aim is to evaluate the influence of diverse premedication protocols on both intraoperative and postoperative pain and anxiety levels in blepharoplasty. Methods: The retrospective study included 98 female patients who underwent blepharoplasty across three different clinical settings in 2023: the Hospital of Lithuanian University of Health Sciences, the Republican Vilnius University Hospital, and a private clinic. The study groups comprised the control group (CG), receiving no premedication, Group A, administered preoperative oral benzodiazepines, and Group B, given a combination of preoperative oral benzodiazepines, EMLA eyelid ointment, and oral Ultracod tablets. Data normality was assessed using the Shapiro-Wilk test, and descriptive statistics included means (±) and median values (minmax). Statistical analyses utilized the Mann–Whitney, Kruskal– Wallis, and ANOVA tests, with a significance level of 0.05 for hypothesis testing. Results: No statistically significant differences were observed in demographic parameters between the three groups. The median age was 53 (37–70), and the mean BMI was 27.36 ± 4.678. An ANOVA test indicated a statistically significant effect of pain during anesthetic injections among the different groups (F(2,95) = 9.066, p = 0.0107). Post hoc analysis using Dunn’s test showed that there was statistically higher pain during anesthetic injections in CG than in Group A and Group B. A significant difference in pain throughout the entire operation was observed among the groups (H(2) = 11.10, p = 0.0039). Dunn’s test indicated that the CG exhibited statistically higher pain during the operation compared to Group B, while no significant difference was found between the CG and Group A. A statistically significant difference was found in preoperative anxiety levels among the groups (F(2, 95) = 3.881, p = 0.024). The Tukey test revealed a statistically higher level of anxiety in the CG (M = 4.12 ± 2.948) compared to Group A (M = 2.47 ± 1.988), with no significant difference between the CG and Group B. No statistically significant differences were observed between the compared groups in terms of postoperative pain (p = 0.6837) and anxiety during the operation (p = 0.0922). Conclusions: All premedication protocols mitigate the perception of injection-related discomfort. Preoperative administration of Benzodiazepines, EMLA eyelid ointment, and oral Ultracod tablets is the most efficacious in alleviating pain throughout the entire surgical procedure, albeit postoperative anxiety is reported to be more pronounced. On the other hand, the administration of benzodiazepines as a stand-alone premedication strategy proves most effective in reducing both pre- and postoperative anxiety. Conversely, premedication demonstrates no significant influence on postoperative pain.