Effect of Benzodiazepines on Reducing Pre-Operative Anxiety

Abstract

Background: Preoperative anxiety is a frequent and clinically significant concern among surgical patients, with substantial effects on perioperative physiology and recovery. Despite widespread use of benzodiazepines for anxiolysis, uncertainties remain regarding their comparative efficacy and safety versus non-pharmacological interventions such as cognitive-behavioral therapy (CBT), guided relaxation, and music therapy. Objective: This study aimed to compare the effectiveness and adverse effects of benzodiazepines, non-pharmacological strategies, and placebo in reducing preoperative anxiety, optimizing postoperative recovery, and enhancing patient satisfaction in adults undergoing elective surgery. Methods: A randomized controlled trial was conducted at a tertiary teaching hospital, enrolling 150 adults aged 18–65 scheduled for elective surgery. Participants with moderate-to-high preoperative anxiety were randomized into benzodiazepine, non-pharmacological (CBT, relaxation, or music), or placebo groups. Exclusion criteria included psychiatric illness, benzodiazepine dependency, severe comorbidities, and emergency procedures. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI) and Amsterdam Preoperative Anxiety and Information Scale (APAIS). Secondary outcomes included physiological stress markers, pain (VAS), length of stay, and adverse events. Statistical analysis used SPSS v25; p<0.05 was considered significant. The protocol received IRB approval and conformed to the Helsinki Declaration. Results: Benzodiazepines produced a 45.5% reduction in STAI scores (95% CI: 41.2–49.8; p<0.001), outperforming non-pharmacological interventions (range 36.0–41.7%) and placebo (3.4%). Sedation (30%) and postoperative cognitive dysfunction (10%) were significantly higher in the benzodiazepine group. Hospital stay and pain scores were lowest with benzodiazepines, but non-pharmacological methods offered a superior safety profile and high patient satisfaction. Conclusion: Benzodiazepines remain highly effective for acute preoperative anxiety reduction, but their adverse effects limit use in vulnerable patients. Non-pharmacological interventions provide clinically meaningful anxiolysis with fewer risks, supporting their integration as primary or adjunctive strategies in surgical care.