Oral Premedication for Operations on the Face under Local Anesthesia: A Placebo-Controlled Double-Blind Trial
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Discussion
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Implication
Randomized double-blind trial reveals oral clonidine provides effective analgesia and anxiolysis with minimal side effects in facial surgery, suggesting it is superior to midazolam and morphine.
Key Points
- To identify an optimal oral premedication for facial surgery under local anesthesia that provides anxiolysis, analgesia, and hemodynamic stability with minimal adverse effects.
- Randomized, double-blind prospective trial conducted from March 1997 to June 1998 involving 150 patients undergoing operations exclusively on the face under local anesthesia.
- Patients were allocated to five parallel groups (n=30 each) receiving oral midazolam (0.15 mg/kg), morphine (0.3 mg/kg), clonidine (1.5 µg/kg), placebo, or an untreated control group.
- Outcomes for anxiety, pain during local anesthetic infiltration, and side effects were independently assessed via patient and surgeon questionnaires.
- Most patients (61%) prioritized pain reduction over anxiety relief (24%), while 8% preferred both and 7% had no preference.
- Pain during local anesthetic administration was significantly lower in the clonidine group (33%) and morphine group (37%) compared to the midazolam group (60%) (p = 0.04).
- Anxiety reduction was greatest in the midazolam and clonidine groups without a statistically significant difference, but clonidine caused fewer hemodynamic fluctuations, nausea, and emesis than morphine.
Cite This Study
Beer et al. (2001) studied this question.