English

Abstract

INTRODUCTION: Regional anesthesia as the name implies is the blocking of peripheral nerve conduction in a reversible manner by using local anesthetic agents, thereby one region of the body is made insensitive to pain and is devoid of reflex response to surgical stimuli. The central nervous system is spared, so the patient is conscious during the surgical procedure. Regional anesthesia offers many advantages over general anesthesia for surgery on upper extremities, particularly in emergency operations. AIM OF THE STUDY: The aim of the present study is to evaluate the effect of addition of 50μg/kg of preservative free Midazolam to 0.5% Bupivacaine solution in supraclavicular brachial plexus block on the • Onset of blockade, • Duration of blockade, • Intensity of blockade, • Sedation, • Complications if any & • Quality of analgesia. MATERIALS AND METHODOLOGY: Forty adult patients of both sexes in the age group of 20 – 60 years belonging to ASA I / II category and their weight ranging between 50 – 70 kgs, posted for various types of upper limb surgeries at the Department of Plastic Surgery, Institute of Research and Rehabilitation of Hand, Government Stanley Hospital, formed the study group. This study was designed as a prospective, randomized comparative study. After receiving the institutional ethical committee approval and informed consent, the patients were randomly allocated into two groups. Supraclavicular brachial plexus was performed via subclavian perivascular technique. Groups: 1. BM - 20 patients received 30 ml of 0.5% Bupivacaine with preservative free Midazolam 50 μg/kg. 2. B - 20 patients received 30 ml of 0.5% Bupivacaine alone. Inclusion Criteria. 1. ASA I & II. 2. Age group 20 – 60 years. 3. Weight 50 – 70 kilograms. 4. Surgeries of forearm and hand. Exclusion Criteria: 1. Patient refusal. 2. Coagulopathy. 3. Infection at injection site. 4. Pneumothorax or previous pneumonectomy on the opposite side. Patients were all preoperatively evaluated, clinically examined and investigations done prior to assessment. Procedures were explained in detail and written consent obtained. The procedure was carried out in the preparation room or in the theatre were facilities for resuscitation were available. SUMMARY: 1. Onset time for both motor and sensory block was quicker in the Bupivacaine with midazolam group. 2. There was no significant difference between the groups in the time taken for completion of both motor and sensory blockade. 3. There was no difference between the groups in the intensity of blockade. 4. There was no difference between the groups in the mean duration of motor blockade. 5. The mean duration of sensory blockade was significantly prolonged in the Bupivacaine midazolam group. 6. Sedation was statistically significant with Bupivacaine midazolam group in the intraoperative period. 7. There was no complication due to the addition of 50μg/kg Midazolam to Bupivacaine. CONCLUSION: In conclusion, midazolam 50μg/kg when used as an additive to 0.5% Bupivacaine solution for supraclavicular brachial plexus block, quickens the onset of sensory and motor blockade, prolongs the duration of sensory blockade and improves the quality of post operative analgesia with mild intraoperative sedation. Hence, midazolam can be considered as a safe additive to local anaestetic solution for brachial plexus block.