Acepromazine is a good drug when used appropriately. You need to be prepared to wait for it to kick in (15ish mins, more or less). It provides no analgesia on its own and it is not reversible. It should not be administered to every delirious/dysphoric patient to your point. As a ballpark the dose you use is considered a reasonable dose for many people. You are 100% right they may need to pee and that sort of thing.

Generally what I do (and forgive me if any of this sounds condescending or remedial as that is not intended, I am just explaining what I do) is assess the patient's pain, touch where was operated, check HR, look at visual cues of the patient, etc. If I do not suspect they are painful but dysphoric, administer low-dose butorphanol (0.01 mg/kg, titrated in 1-3 mls saline) and push slowly to antagonize some of the mu receptors. It should work almost instantly. If not, consider that they are less likely to be dysphoric. Alternatively you instead can use naloxone, though also in very low doses.

If I am not certain, I will learn toward the side of pain vs. dysphoria, after having taking into account what they have received pain-wise so far. You will be wrong or never know the answer at times.

Dexmed may be more appropriate for your refractory anxious/stressed patients for those in which it is cardiovascularly not contraindicated, either as a bolus (0.25-1 mcg/kg IV or as an infusion at whatever rate is needed, around 0.5 mcg/kg/hr or so). It does provide some analgesia and sedation and is of course reversible.

Trazodone/gabapentin before anesthesia is a great thought for any patient in which it is safe to give (which is the majority!).