The Effect of Low-Dose Dexmedetomidine Nasal Spray on Anxiety Levels in Gynaecological Patients on the Day of Surgery: A Randomised Controlled Study

Purpose: To evaluate the effects of dexmedetomidine nasal spray on preoperative anxiety, perioperative sleep, and intraoperative haemodynamic stability in patients undergoing laparoscopic hysterectomy or myomectomy. Methods: This is a prospective, randomised, double-blind, placebo-controlled, single-centre clinical trial. Between October 2025 and February 2026, female patients scheduled for laparoscopic hysterectomy or myomectomy who, prior to surgery, had a HAMA score of ≥ 14 and a VAS-A anxiety score of ≥ 5 were rigorously screened and enrolled. Eligible patients were randomly assigned (1:1) to receive either intranasal dexmedetomidine 50 μg or 0.9% saline placebo on the night before surgery.A double-blind design was adopted for both patients and outcome assessors throughout the study. The primary outcome measure was the Visual Analogue Scale for Anxiety (VAS-A) score recorded at 7:00 on the day of surgery (V 3 ). Secondary endpoints included changes in the coefficient of variation of heart rate (HR) and the coefficient of variation of mean arterial pressure (MAP) during surgery; VAS-A at various perioperative time points; The number of vasoactive drug administrations and opioid usage in two patient groups during surgery; Assessment of sleep changes before and after pharmacological intervention using Athens Insomnia Scale (AIS) scores; Recording of adverse reaction incidence post-intervention and post-operatively. Results: Group D had a significantly lower VAS-A score at 7:00 on the day of surgery than Group C (Group C; 5.92± 0.89 VS Group D:4.77± 0.82, 90% CI:0.885∼ 1.405, P < 0.0001). The coefficients of variation for both intraoperative MAP and HR were significantly lower in Group D than in Group C (MAP-CV: 7.02± 2.88% vs 13.12± 4.75%, P < 0.001; HR-CV: 6.29± 2.79% vs 10.81± 3.86%, P < 0.001).The overall Postoperative adverse reactions rate was lower in Group D than in Group C (60% vs 80%, P < 0.05). Ciprofol consumption was markedly lower than in Group C ( P < 0.0001). There was no significant difference in complications following drug intervention between the two groups (3.33% vs 8.33%, P =0.413). Conclusion: The use of a 50-microgram dexmedetomidine nasal spray on the evening prior to surgery reduces anxiety scores on the day of surgery in patients undergoing gynaecological procedures, improves perioperative sleep quality, and maintains haemodynamic stability during the operation. Keywords: general anaesthesia, dexmedetomidine, preoperative anxiety, hysterectomy, myomectomy, sleep disorders