title: Lorazepam does not improve the quality of recovery in day-case surgery patients: a randomised placebo-controlled clinical trial.
abstract: BACKGROUND
  In day-case surgery, the effects of the anxiolytic lorazepam as premedication on the quality of postoperative recovery are unknown.
  
  
  OBJECTIVE
  To evaluate whether lorazepam as a premedication beneficially affects quality of recovery (primary outcome) and psychological manifestations (secondary outcome) after day-case surgery.
  
  
  METHODS
  A randomised, double-blind, placebo-controlled clinical trial.
  
  
  METHODS
  Single tertiary centre.
  
  
  METHODS
  
  
  
  METHODS
  day-case surgery; age at least 18 years.
  
  
  METHODS
  insufficient knowledge of the Dutch language; intellectual disability; ophthalmology surgery; extracorporeal shock wave lithotripsy; endoscopy; botulinum toxin A treatment; abortion; chronic pain treatment; preceding use of psychopharmaceuticals; contraindication to lorazepam.
  
  
  METHODS
  Lorazepam (1 to 1.5 mg) intravenously vs. NaCl 0.9% as a premedication prior to surgery.
  
  
  METHODS
  Quality of Recovery-40 (QoR-40) score.
  
  
  RESULTS
  State-Trait Anxiety Inventory (STAI-State/Trait); State-Trait Anger Scale (STAS-State/Trait); Multidimensional Fatigue Inventory (MFI); Hospital Anxiety and Depression Scale (HADS). Timing of evaluation: T0: preoperatively (all scales); T1: before discharge (STAI-State/Trait); T2: first postoperative working day (QoR-40); T3: 7th day after surgery (all scales). Robust regression analysis was applied. Statistical analyses were adjusted for the corresponding baseline value and sex.
  
  
  RESULTS
  Four hundred patients were randomised; 398 patients were analysed. Postoperative mean QoR-40 scores were similar in both groups at T2 (174.5 vs. 176.4, P = 0.34) and T3 (172.8 vs.176.3, P = 0.38). Postoperative mean STAI-State/Trait scores decreased less in the group with lorazepam at T1 (32.3 vs. 29.3, P < 0.0001; 32.7 vs. 30.8, P = 0.0002). STAI-Trait and HADS-Anxiety decreased less in the group with lorazepam at T3 (31.1 vs. 30.0; P = 0.03, 3.3 vs. 2.5, P = 0.003). STAS-State increased in the group with lorazepam at T3 (10.8 vs. 10.3, P = 0.04).
  
  
  CONCLUSIONS
  In day-case surgery, lorazepam as a premedication did not improve quality of recovery. Furthermore, this premedication may delay the decrease in postoperative anxiety and aggression.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01441843.
authors: From the Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors: Herjan
authors: H
authors: Mijderwijk
authors: Stefan
authors: S
authors: van Beek
authors: Markus
authors: M
authors: Klimek
authors: Hugo J
authors: HJ
authors: Duivenvoorden
authors: Frank
authors: F
authors: Grüne
authors: Robert Jan
authors: RJ
authors: Stolker
mesh_terms: D000328:Adult; D000374:Aggression / Q000187:drug effects; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008140:Lorazepam / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011292:Premedication / Q000379:methods; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis
chemical_list: D014151:Anti-Anxiety Agents; D008140:Lorazepam