Melatonin and Alprazolam as Anxiolytic Agents in Minor Oral Surgical Procedures - A Comparative Study.

Abstract

Introduction: Dental anxiety has a major impact on patient compliance, which frequently requires pre-operative pharmacological intervention. Although commonly utilised, melatonin, an endogenous hormone with analgesic and anxiolytic effects and alprazolam, a short-acting benzodiazepine, are not frequently compared in minor oral surgical procedures. This study compares melatonin and alprazolam as anxiolytic and analgesic agents in patients undergoing minor oral surgical procedures.

Materials and methods: In a triple-blind, randomised controlled trial, 42 American Society of Anesthesiologists (ASA) I/II patients (ages 20-50) with pre-operative anxiety (visual analogue scale [VAS] >50) were randomly assigned to either oral melatonin 3 mg (Group A) or oral alprazolam 0.5 mg (Group B) one hour prior to surgery. Pre-, intra- and postoperatively, anxiety (VAS, Trail Making Test), sedation (Ramsay Sedation Scale) and recovery (Modified Aldrete Score) were evaluated. The Mann-Whitney U and Wilcoxon signed-rank tests (SPSS v25) were used for statistical analysis.

Results: Both groups showed a significant intra-group decrease in VAS anxiety scores (P < 0.001). A post-operative inter-group comparison showed that melatonin provided superior anxiolysis (P = 0.03) and less sedation (P = 0.01). The modified Aldrete scores were similar (P = 1.00), and no negative effects were noted.

Discussion: Although both treatments are successful in lowering perioperative anxiety, melatonin's superior anxiolytic effects and a positive sedation-recovery profile make it a potential substitute for benzodiazepines in minor oral surgical operations.