The impact of preoperative alprazolam (Xanax) on surgical experience and pain perception during refractive surgery

Purpose: To evaluate the effect of preoperative alprazolam (Xanax) on intraoperative pain perception, perception of waiting time and surgery duration, and overall satisfaction with refractive surgery. Setting: Care Vision Laser Center, Tel Aviv, Israel. Design: Retrospective case-control study. Methods: Patients undergoing refractive surgery on consecutive days were systematically offered 0.5 mg of oral alprazolam (Xanax) 30–60 min before surgery, with the option to decline. On other days patients were not offered the medication. Regardless of alprazolam (Xanax) use, all patients completed preoperative anxiety and postoperative “surgery satisfaction” questionnaires as part of routine quality audits. The questionnaires assessed anxiety, intraoperative pain perception, perception of waiting time, perception of surgery duration, and overall surgical experience, rated on a five-point Likert scale. Local anesthesia was standard for all patients Results: A total of 166 patients were included, of whom 54 (32.5 %) received alprazolam (Xanax). Patients who received alprazolam (Xanax) reported significantly lower intraoperative pain perception (p = 0.04), shorter perception of waiting time (p = 0.008), shorter perception of surgery duration (p < 0.001), and a more favorable surgical experience (p < 0.01). Ordinal logistic regression identified alprazolam (Xanax) use as the strongest predictor of a favorable experience (B = 1.00, p < 0.001), with patients nearly three times more likely to report a positive experience. Conclusion: Preoperative alprazolam (Xanax) significantly improved patient-reported surgical experience by reducing intraoperative pain perception and improving perception of waiting time and surgery duration. These findings support the role of anxiolytic premedication in optimizing perioperative comfort in refractive surgery.