Discussion
anxiety
The purpose of this study was to determine if patients premedicated with pregabalin would report similar improvements (decreases) in anxiety as those who received the standard treatment, diazepam, for anxiety in this population. The findings indicated that the patients who received the 2 medications evidenced similar improvements in anxiety overtime. However, and unexpectedly, we also found that those who received placebo evidenced deceases in anxiety, and that the anxiety decreases associated with the active treatments were not significantly greater than those that occurred with placebo treatment.Preoperative anxiety is common. The prevalence of clinically meaningful preoperative anxiety has been shown to vary from 12.6 to 59.6%In this study, we utilized 3 tools, the VNRS, APAIS and STAI, to measure preoperative baseline anxiety level before receiving any medications. After the patients had received both the night and on the day of surgery doses of study medications, we employed the VNRS and APAIS to assess the effects of these medications on preoperative anxiety level. All of our patients experienced preoperative anxiety. Our study has shown no significant reduction in preoperative anxiety after receiving pregabalin, diazepam or placebo. This finding is consistent with the results of a systematic review conducted in 2015, which found that the role of pregabalin in reduction of preoperative anxiety measured by visual analog scale in elective surgery remained inconclusiveStudies conducted by Fassoulaki et al.At the same time, many studies have found a positive association between premedication with pregabalin and reducing preoperative anxiety. Gonano et al.The inconstant findings of the efficacy of pregabalin to reduce preoperative anxiety may be related to confounding factors such as different study population, doses and timing of pregabalin administration, as well as methods and timing of anxiety assessment.Regarding comparison of anxiolytic effect between pregabalin and diazepam, one randomized control trial conducted by Jokela et al.Regarding sleep quality, the available data have showed that pregabalin has positive benefits on sleep quality. In rats, pregabalin has been shown to decrease the duration of rapid eye movement sleep (REMS) and significantly increased non rapid eye movement sleep (NREMS)We also found that patients receiving either pregabalin or diazepam had higher sedation scores in comparison to placebo. This finding was consistent with previous studiesThis study aimed to compare the preoperative anxiolytic effect of pregabalin with an active comparator, diazepam as well as placebo. We incorporated 2–3 anxiety assessment tools for confirming patients’ preoperative anxiety level. This study has a number of limitations which should be considered when interpreting the findings. First, our study population consisted of patients scheduled for various kinds of elective surgical procedures as this might pose different influence on preoperative anxiety level. We might have found greater efficacy of one or both of the medications studied had we limited that sample to a single type of surgery or surgical procedure with higher anxiety. Our study participants underwent elective surgery so the results may not be valid to surgical patients with urgent or emergent indications. Also, it is important to note that oral pregabalin is rapidly and completely absorbed with peak level within 1 h and over 90% bioavailabilityDespite these limitations, the study provides information regarding the effects of both pregabalin and diazepam for reducing preoperative anxiety. In a fully powered study that included more subjects than have been included in prior studies, allowing for a direct head-to-head comparison of pregabalin with diazepam, and both of these medications with placebo, and using 2 valid measures of anxiety, we found that in the population studied, while the 2 active treatments were associated with similar beneficial effects, neither evidenced larger effects on preoperative anxiety than placebo. Their findings suggest the possibility that neither treatment may be effective for reducing anxiety for all patients undergoing surgery. More research is therefore needed to help determine the specific populations that might be most responsive to either or both treatments.