The impact of premedication protocols on preoperative anxiety, intraoperative and postoperative pain, and anxiety in blepharoplasty

Abstract

Background and aim of the study. Blepharoplasty is a common cosmetic procedure, often performed under local anaesthesia for efficiency and safety. Premedication, including sedatives and analgesics, aims to improve patient comfort and experience during surgery. This study evaluates various premedication protocols’ effects on intraoperative and postoperative pain and anxiety levels in blepharoplasty. Methods and materials. In this retrospective study of 98 female blepharoplasty patients across three clinical settings in 2023, including the Lithuanian University of Health Sciences Hospital, Vilnius University Hospital, and a private clinic. Three groups were analyzed: the control group (CG) with no premedication, Group A receiving oral benzodiazepines, and Group B receiving a combination of oral benzodiazepines, EMLA eyelid ointment, and oral Ultracod tablets. Data normality was assessed using the Shapiro-Wilk test, and statistical analyses employed Mann- Whitney, Kruskal-Wallis, and ANOVA tests (p < 0.05). Results. No significant demographic differences were found among the three groups, with a median age of 53 years (range: 37-70) and a mean BMI of 27.36 ± 4.678. ANOVA revealed significant differences in pain during anaesthetic injections (p = 0.0107), with CG experiencing higher pain than Group A and B. Group differences persisted throughout the operation (p = 0.0039), with CG showing higher pain than Group B. Preoperative anxiety levels differed significantly (p = 0.024), with CG having higher anxiety than Group A. However, no significant differences were found in postoperative pain (p = 0.6837) or anxiety during the operation (p = 0.0922). Conclusions. Premedication effectively reduces injection-related discomfort. The combination of benzodiazepines, EMLA eyelid ointment, and Ultracod tablets is most effective in reducing pain during surgery, albeit with increased postoperative anxiety. Benzodiazepines alone are effective in reducing both pre-and postoperative anxiety. However, premedication does not significantly affect postoperative pain and anxiety during the operation levels in blepharoplasty patients.