Effects of estazolam, remimazolam and their combination on preoperative anxiety and postoperative pain after gynecological laparoscopic surgery: a double-blind, randomized, controlled trial

Abstract

Abstract Purpose Preoperative anxiety is closely related to postoperative pain, and high preoperative anxiety can aggravate postoperative pain. We aimed to estimate the effect of estazolam, remimazolam, and their combination on preoperative anxiety and postoperative pain in patients undergoing elective gynecological laparoscopic surgery. Materials and Methods We carried out a randomized, double-blind, placebo-controlled experiment between October 2020 and April 2021. A total of 108 patients were split into four groups: (1 mg estazolam or starch was taken orally on the evening before surgery; 0.1 mg/kg remimazolam or normal saline was administered intravenously after entering the operating room) Group E received estazolam and normal saline; Group R received starch and remimazolam; participants in Group ER were given not only estazolam but also remimazolam; participants in Group C were given starch and normal saline. We recorded preoperative anxiety scores (visual analog scale–anxiety [VAS-A]), pain scores (VAS), and cumulative sufentanil consumption after laparoscopic surgery. Results The mean anxiety scores were significantly lower in Group E, R, and ER than in Group C before surgery. Compared with Group C, mean pain scores were significantly lower in Group ER at 0.5, 1, 4, 8, 24, 48, and 72 hours after surgery and lower in Group R or E at 4, 8, and 24 hours after surgery. The mean pain scores in Group E (at 8 and 24 postoperative hours) and Group R (at 8 postoperative hours) were both significantly higher than those in Group ER. Moreover, the mean cumulative sufentanil consumption was significantly lower in Group ER at 0.5, 1, 4, 8, 24, 48, and 72 hours after surgery and lower in Group E or R at 0.5 hours after surgery, compared with Group C. Conclusion The preoperative application of estazolam, remimazolam, and their combination can relieve preoperative anxiety and postoperative pain for patients undergoing gynecological laparoscopic surgery. Moreover, the preoperative combination can also significantly reduce postoperative sufentanil consumption.