Effects of perioperative benzodiazepine administration on postoperative patient-reported outcomes: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND: Benzodiazepines are administered during the perioperative period because they are believed to improve the patient experience. We conducted a systematic review and meta-analysis evaluating the effect of perioperative benzodiazepines on postoperative patient-reported outcomes. METHODS: We included randomised controlled trials of all languages comparing benzodiazepines with non-benzodiazepine comparators in adults undergoing inpatient surgery. Our outcomes were postoperative pain, quality of recovery, patient satisfaction, and anxiety. We assessed risk of bias using a modified Cochrane tool. We pooled data using a random-effects model and assessed the quality of evidence for each outcome using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: We screened 33 220 abstracts, 1156 full texts, and 123 RCTs, of which 93 were included in the quantitative synthesis. We identified moderate certainty evidence that benzodiazepines have no effect on patient-reported postoperative pain or quality of recovery and very low certainty evidence that benzodiazepines have no effect on patient satisfaction. We identified low certainty evidence that benzodiazepines result in higher levels of postoperative anxiety (22 trials, n=2165; mean difference, 2.18 points on the 20-80 State-Trait Anxiety Inventory Scale; 95% confidence interval, 1.05-3.30; I²=90%). CONCLUSIONS: Benzodiazepine administration in the perioperative period probably has no effect on postoperative pain or quality of recovery and has an uncertain effect on patient satisfaction (very low certainty evidence). When compared with placebo or another agent, benzodiazepines might result in higher levels of postoperative anxiety. Definitive research is required to determine whether the balance of risks and benefits justifies using benzodiazepines during the perioperative period to improve patient-reported outcomes. SYSTEMATIC REVIEW PROTOCOL: PROSPERO (CRD42023440326).