Abstract
Background: Spinal anaesthesia is a common anaesthetic technique for lower limb surgery. Many adjutants have been tried to prolong the duration of analgesia provided by local anaesthetics when administered intrathecally. Midazolam has been shown to prolong the duration of analgesia when used as an adjuvant, providing the added advantages of mild sedation and amnesia, while being devoid of neurotoxicity, and the adverse effects of opioids. This study was designed to evaluate the effect of 1 mg preservative-free intrathecal midazolam added to spinal bupivacaine during postoperative analgesia, and the incidence of adverse effects, if any, in patients undergoing knee arthroscopies. Method: 60 consenting American Society of Anesthesiologists (ASA) physical status I or II patients of either gender (men = 48, women = 12), aged between 20-60 years, were randomly allocated to two groups (30 each). Group B received 0.5% hyperbaric bupivacaine with saline intrathecally, and Group BM received 0.5% hyperbaric bupivacaine with preservative-free midazolam 1 mg intrathecally. Peak sensory level, total duration of analgesia, duration of motor blockade, pain score using the Visual Analogue Scale, and sedation score using the Observer Assessment Score of Sedation were assessed, along with vital parameters, namely heart rate and systolic, diastolic and mean blood pressure. Results: The total duration of analgesia observed was significantly higher in Group BM (336.2 ± 37.50minutes) vs. Group B (151.17 ± 15.41 minutes), and the pain score was lower in Group BM (33.6 ± 4.68 mm) vs. Group B (56.6 ± 8.64 mm). Conclusion: The addition of preservative-free midazolam 1 mg to intrathecal 0.5% hyperbaric bupivacaine prolongs the duration of analgesia without any observed adverse effects in patients undergoing lower limb surgeries.
Highlights
One of the primary aims of anaesthesia is to alleviate the patient’s pain and agony, there by permitting the performance of surgical procedures without any discomfort
The addition of preservative-free midazolam 1 mg to intrathecal 0.5% hyperbaric bupivacaine prolongs the duration of analgesia without any observed adverse effects in patients undergoing lower limb surgeries
This study was carried out to study the effect of addition of 1mg intrathecal Midazolam to bupivacaine in humans with the objectives to compare the mean period of analgesia for intrathecal Midazolam 1mg plus bupivacaine and bupivacaine alone and to compare the side effects of intrathecal Midazolam (1mg) plus bupivacaine and bupivacaine alone
Summary
One of the primary aims of anaesthesia is to alleviate the patient’s pain and agony, there by permitting the performance of surgical procedures without any discomfort. Many authors have suggested the addition www.ssjournals.com of Midazolam to bupivacaine to extend the period of analgesia 1,2,3. Many of these studies were based on the animal models. Many adjutants have been tried to prolong the duration of analgesia provided by local anaesthetics when administered intrathecally. Midazolam has been shown to prolong the duration of analgesia when used as an adjuvant, providing the added advantages of mild sedation and amnesia, while being devoid of neurotoxicity, and the adverse effects of opioids. This study was designed to evaluate the effect of 1 mg preservative-free intrathecal midazolam added to spinal bupivacaine during postoperative analgesia, and the incidence of adverse effects, if any, in patients undergoing knee arthroscopies
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