Abstract
Introduction: Hyperbaric Bupivacaine is the extensively used local anesthetic but the major disadvantage is profound sympathetic blockade leading to hypotension and prolonged duration of motor block. The addition of Fentanyl or Midazolam can provide excellent quality and prolong the duration of analgesia. The study aims to compare the effect of intrathecal Fentanyl with that of intrathecal Midazolam in combination with 0.5% hyperbaric Bupivacaine on the duration and quality of spinal anesthesia in patients undergoing appendicectomy.Materials and Methods: This is a prospective, comparative and interventional study where patients were randomized into two equal groups. The study was conducted in a tertiary referral hospital from July 2018 to December 2018 after ethical approval. Group BF received Fentanyl and group BM received Midazolam The outcomes measured were, peak sensory level, quality of intraoperative analgesia and motor block, duration of effective analgesia, intraoperative and postoperative complications.Results: A total of 44 patients were studied with 22 in each arm. The two groups were comparable in terms of age, weight, height, duration of surgery, and ASA status of the patients. Peak sensory level and degree of motor block were not statistically different in the two arms. Duration of effective analgesia was 293.16±35 min in the BF group and 267.80±32 min in the BM group (p=0.01). Increased incidence of pruritus was recorded during the postoperative period in the Fentanyl group.Conclusions: Fentanyl and Midazolam both are equally effi cient adjuvant added to hyperbaric Bupivacaine for intrathecal use to improve the quality of spinal anesthesia in patients undergoing appendicectomy.
Highlights
Hyperbaric Bupivacaine is the extensively used local anesthetic but the major disadvantage is profound sympathetic blockade leading to hypotension and prolonged duration of motor block
Increased incidence of pruritus was recorded during the postoperative period in the Fentanyl group
Fentanyl and Midazolam both are efficient adjuvant added to hyperbaric Bupivacaine for intrathecal use to improve the quality of spinal anesthesia in patients undergoing appendicectomy
Summary
Hyperbaric Bupivacaine is the extensively used local anesthetic but the major disadvantage is profound sympathetic blockade leading to hypotension and prolonged duration of motor block. Spinal anesthesia for its numerous advantages over general anesthesia makes it the anesthesia of choice in the present surgical practice.[1] Hyperbaric Bupivacaine is the most widely used local anesthetic but the major disadvantage is profound sympathetic blockade leading to hypotension and prolonged duration of motor block.[2] Despite achieving an adequate block, some patients under spinal anesthesia may experience some degree of visceral discomfort during appendicectomy under spinal anesthesia.[3]. Several additives (opioids, clonidine, neostigmine, ketamine, midazolam, etc) used as an adjunct with intrathecal injection of local anesthetic solutions are aimed at improving the quality and duration of spinal block and postoperative analgesia, or to minimize the dose of a local anesthetic to reduce the extent and effects of sympathetic blockade.[4]. Addition of Fentanyl or preservativefree midazolam to Bupivacaine for spinal anesthesia has shown promising results in various studies at improving the duration and quality of anesthesia and analgesia with smaller doses of Bupivacaine.[7,8,9,10] But there are very few studies done in our part of the world to compare Midazolam and Fentanyl used as adjuncts with spinal Bupivacaine to evaluate the superiority of one over the other
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
