Oral premedication for operations on the face under local anesthesia: A placebo-controlled double-blind trial

Modern strategies for preventing or controlling pain and anxiety demand a p remedication for operations using local anesthesia and for those using seda tion or general anesthesia. For optimal patient care, the premedication sho uld be given orally and, with respect to the outpatient basis of the operat ions, should have a short recovery period. Midazolam, one of the most favor ed premedications for general anesthesia, has been recommended as a premedi cation for operations using local anesthesia as well. However, midazolam. h as only sedative-anxiolytic effects and does not reduce pain sensation, whi ch should be mandatory for operations using local anesthesia. A further req uirement is the maintenance of stable hemodynamics for the prevention of po stoperative hematomas, especially in the face. For these reasons, another p remedication meeting all requirements (anxiolysis, analgesia, and stable he modynamics) was researched. A randomized, double-blind prospective study wa s performed from March of 1997 to June of 1998. Five groups totalling 150 p atients were included in the study; each -roup contained 30 patients who ha d operations performed solely on the face. In the first four groups, the ef fect of midazolam (0.15 mg/kg(-1)), morphine (0.3 mg/kg(-1)), and clonidine (1.5 mug/kg(-1)) administered orally was compared with a placebo. The fift h group was the control group and received no premedication. To evaluate th e effects of the premedications, a corresponding questionnaire was complete d independently by the patient and surgeon. With regard to the anxiolytic o r analgesic properties of the premedication, 61 percent of the patients pre ferred pain reduction to anxiety control, and 24 percent of patients prefer red reduction of anxiety. The remainder insisted on a reduction of both pro pel-ties (8 percent) or had no preference (7 percent). Reduction of anxiety was largest in the midazolam and the clonidine groups, but the difference was not significant. The least pain during the application of local anesthe sia was experienced by the morphine group (37 percent) and the clonidine gr oup (33 percent), in contrast to the midazolam group (60 percent) (p = 0.04 ). Morphine and clonidine met the requirements of pain reduction equally we ll. Nevertheless, considering the rate and intensity of adverse effects wit h respect to hemodynamic compromises, nausea, and emesis, clonidine is even better suited as an oral premedication for operations on the face using lo cal anesthesia.