Preoperative Oxytocin Linked to Fewer Acute Stress Symptoms After Fracture Surgery

In a single-center, double-blind randomized trial of 328 adults undergoing traumatic fracture surgery, a preoperative dose of intranasal oxytocin was associated with fewer positive screens for probable acute stress disorder over three days than saline. The findings are promising, but longer-term outcomes and safety require further study.

328 adults were randomized at a single Chinese hospital.
ASD screening positivity was 15.9% with oxytocin versus 30.5% with saline.
Follow-up for the primary outcome was limited to three days.
No serious adverse events were observed.

Acute stress disorder (ASD) can follow traumatic fracture surgery, but pharmacological prevention strategies are lacking. In a prospective, double-blind, placebo-controlled trial at one hospital in China, 328 adults scheduled for fracture surgery were randomized to receive 40 IU of intranasal oxytocin or saline 10 minutes before anesthesia induction. The primary outcome was a first screening-positive result for probable ASD within three days, defined as a Stanford Acute Stress Reaction Questionnaire score of 40 or higher.

A positive screen occurred in 26 of 164 patients (15.9%) assigned oxytocin and 50 of 164 (30.5%) assigned saline. The risk difference was −14.6 percentage points (95% CI, −23.5 to −5.5), and the risk ratio was 0.52 (95% CI, 0.34-0.79). The adjusted hazard ratio was 0.45 (95% CI, 0.27-0.75). No serious adverse events were observed. Exploratory analyses suggested improvements in psychological outcomes and changes in stress biomarkers.

The results suggest a possible short-term preventive effect in this study population, but do not establish long-term benefit or safety. The single-center setting and short follow-up limit generalizability; the study assessed screening-positive probable ASD, not a confirmed diagnosis. Further research is needed before these findings support changes in perioperative practice.

In practice

For adults undergoing traumatic fracture surgery, this single-center randomized trial found fewer screening-positive probable acute stress disorder results within three days after a single preoperative intranasal oxytocin dose than after saline. This is promising evidence, not a basis to change perioperative practice: the outcome was a screening result rather than confirmed diagnosis, follow-up was brief, and long-term safety and benefit remain uncertain. The findings may not generalize beyond the study setting and require confirmation in further trials.

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Source

JAMA Internal Medicine: Preoperative Intranasal Oxytocin and Probable Acute Stress Disorder After Traumatic Fracture Surgery ↗

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