A Randomized Single Blinded Study Comparing the Effects of Oral Melatonin with Oral Alprazolam Used as Premedication in Adult Patients Undergoing Surgery Under General Anaesthesia

Preoperative anxiety is a common problem among surgical patients and may adversely affect perioperative hemodynamic stability, anesthetic requirements, recovery profile, and patient satisfaction. Benzodiazepines such as alprazolam are widely used for anxiolysis but are associated with sedation, cognitive impairment, and delayed recovery. Melatonin has emerged as a potential alternative premedicant with anxiolytic and sedative properties and fewer adverse cognitive effects.Objectives:To compare the effects of oral melatonin and oral alprazolam as premedicants in adult patients undergoing elective surgery under general anesthesia. Methods:This prospective randomized single-blinded comparative study included 90 adult patients (ASA I and II) scheduled for elective surgeries under general anesthesia. Patients were randomly allocated into two groups of 45 each. Group M received oral melatonin 9 mg and Group A received oral alprazolam 0.5 mg, administered 120 minutes before surgery. Anxiety was assessed using the Visual Analogue Scale (VAS), sedation using Ramsay Sedation Score (RSS), orientation using orientation scores, and cognitive function using Digit Symbol Substitution Test (DSST). Hemodynamic parameters and adverse effects were also recorded.Results:Both groups showed significant reduction in anxiety after premedication; however, melatonin produced greater anxiolysis (VAS: 2.3 ± 0.8 vs 3.1 ± 0.9; p=0.001). Alprazolam produced deeper sedation (RSS: 3.5 ± 0.6 vs 2.9 ± 0.5; p=0.003) and greater cognitive impairment (DSST: 52.1 ± 6.3 vs 60.7 ± 5.2; p=0.0001). Melatonin demonstrated better orientation, improved hemodynamic stability, and fewer adverse effects.Conclusion:Oral melatonin is an effective and safer alternative to alprazolam as a premedicant, providing superior anxiolysis with better preservation of cognitive and psychomotor function and fewer adverse effects.