Comparative study of intrathecal fentanyl mixed with bupivacaine, tramadol mixed with bupivacaine, midazolam mixed with bupivacaine for peri and post-operative pain relief in lower limb and lower abdominal surgery

Abstract

Background: Pain relief is of much importance in patients undergoing surgery during perioperative and post-operative period. Various methods have been evolved for providing post-operative pain relief. After effective pain relief a smoother post operative period and early discharge from the hospital is anticipated. Intrathecal and epidural narcotics have been widely used to relieve pain and provide post-operative analgesia. Intrathecal and epidural narcotics have been widely used to relieve pain and provide post-operative analgesia. Here three drugs tramadol, fentanyl, and midazolam used as adjuvant with bupivacaine in intrathecal injection for post operative pain lelief and comparative study had been done. Material and Methods: After the study protocol was approved by the Ethical clearance committee of the IGIMS, Sheikhpura, Patna. Study design was prospective, randomised and double blind techniques. A group of 100 patients undergoing lower abdominal and lower limb surgery were included in the study. Every patient was fully explained about the anaesthesia and surgical procedure before inclusion in the study. The patients were in the (25 – 65) years age group and belonged to the American Society of Anaesthesiologist (ASA) physical status class I- II and scheduled for lower abdominal and lower limbs surgery were randomly allocated to four groups with equal number: group B [Bupivacaine (0.5)% 3 cc +.4 cc normal saline], group BT [Bupivacaine (0.5)% 3 cc + 25 mg tramadol], BM [Bupivacaine (0.5)% 3 c.c + 2 mg midazolam], BF [Bupivacaine (0.5)% 3 cc + 20 μg fentanyl]. All additive drugs used intrathecally were preservative free. All intrathecal punctures were performed in the lateral (Right or Left) position with a (25G) Quinke needle, using the midline approach at the L3-L4 intervertebral space. Results: The study revealed that administration of additives in group BM and group BF did prolong analgesia. In group B, duration of analgesia and mean duration of rescue analgesic requirement was (3.22 + 1.16) hrs. For group BM it was (12.1+ 2.34) hrs, for group BF (7.6 + 2.86) hrs, for group BT (3.65 + 1.42) hrs. Degree and duration of motor blockade was slightly prolonged in group BM and there was mild modulation in group BF. Conclusion: Addition of adjuvants (fentanyl, midazolam) to intrathecal bupivacaine for perioperative pain relief does prolong postoperative analgesia and improves the intraoperative quality of analgesia than bupivacaine alone.