Oral propranolol--efficacy and comparison of two doses for peri-operative anxiolysis

Patients undergoing surgery are having high levels of anxiety and stress. Though not life threatening it adds an unnecessary financial burden to the hospital. We assessed the anxiolytic effects of oral propranolol 20 mg and 40 mg when given as premedication. This is a double blind, randomised, prospective clinical study involving 60 healthy patients (ASA I and II) undergoing minor elective surgery. Subjects in control group without any anxiolytic premedication (group I, n = 20) were compared with those receiving oral propranolol 20 mg (group II, n = 20) or 40 mg (group III, n = 20) with sips of water 2-hour prior to surgery. Anxiety level was assessed using 4-point anxiolysis score (1--tearful, 2--anxious but easily reassured, 3--calm, 4--asleep) in the holding area, after entering operating room, immediate postoperative and 2 hours after surgery. Fluctuation in pulse rate and BP was recorded. Statistical data was analysed using one-way ANOVA with posthoc test.Value of p < 0.05 was taken as significant. Twenty subjects in each group were required as calculated from reference study with difference of up to 30%, type I error of 0.5 and power of 80%. Anxiolysis score in operating room (group I--1.40 +/- 0.48, group II--1.95 +/- 0.58, group III--1.90 +/- 0.53) and immediate postoperative period (group I--1.25 +/- 0.43, group II--1.90 +0.53, group III--2.10 +/- 0.29) were significantly improved (p < 0.05) in groups II and III compared with control group. Variations in systolic BP and pulse rate were less in test groups (p < 0.05). No statistically significant difference was found after Intergroup comparison of test groups. Bradycardia (25%) and hypotension (10%) were more with 40 mg propranolol. Both 20 mg and 40 mg doses of propranolol are effective for pre-operative anxiolysis but 20 mg dose gives significant reduction in anxiety with minimal side-effects. Thus 20 mg propranolol premedication for reducing peri-operative anxiety and for cardiovascular stability is recommended.