Does intrathecal midazolam improve hyperbaric bupivacaine-fentanyl anesthesia in elderly patients?

Abstract

Objective To assess the effect of intrathecal midazolam with bupivacaine-fentanyl in elderly patients undergoing endourologic procedures. Materials and methods This prospective, randomized, double-blind study involved 60 ASA physical status II-III patients aged over 60 years scheduled for elective endoscopic urologic procedures under spinal anesthesia with hyperbaric bupivacaine 0.5% (5 mg/ml). They were randomized into one of three equal groups of 20 patients each: the first group, control group (group C), received 7.5 mg hyperbaric bupivacaine 0.5% in a volume of 1.5 ml; the second group, fentanyl group (group F), received 7.5 mg hyperbaric bupivacaine 0.5% in a volume of 1.5 ml and 10 mg fentanyl (0.1 ml); and the third group, fentanylmidazolam group (group FM), received 7.5 mg hyperbaric bupivacaine 0.5% in a volume of 1.5 ml and 10 mg fentanyl (0.1 ml) plus 1.0 mg of midazolam (0.2 ml). Sensory and motor effects were assessed. Postoperative pain, sedation, and adverse effects were also recorded. Results The three studied groups were comparable in demographic and clinical characteristics. They were hemodynamically stable. There was no significant difference between the three groups in the onset of sensory ( P = 0.721) and motor block ( P = 0.342), duration of motor block ( P = 0.286), and sedation score ( P = 0.229). Duration of sensory block was prolonged in group F compared with the control group ( P P = 0.065). Time to first request of rescue analgesic was significantly longer in group F compared with the C group ( P = 0.033) and in FM compared with the F group ( P P = 0.547). Conclusion Adjuvant intrathecal midazolam resulted in intraoperative hemodynamic stability and safely potentiates postoperative analgesic effect of bupivacainefentanyl spinal anesthesia in elderly patients undergoing endourologic procedures.