Preemptive analgesia with midazolam and diclofenac for hernia repair pain

Abstract

The aim of this study was to compare the preemptive effects of systemic midazolam and diclofenac on postoperative analgesia when used before surgical incision. Ninety patients, aged 35-65years, scheduled for hernia repair surgery were included in the study. Forty five patients in the midazolam group (group M+D) received 0.05mg/kg midazolam and 1.5mg/kg diclofenac, 15min before surgical incision; 45 patients in the diclofenac group (group D) received diclofenac without midazolam, 15min before surgical incision. Postoperative pain (Verbal Rating Scale-6) score and first analgesic requirement were noted. Sedation levels were evaluated with Observer's Assessment of Alertness/Sedation (OAA/S) score. Adverse effects during and after the operation were also recorded. Group M+D had a significantly lower proportion of patients who exhibited postoperative pain than group D (11.1% vs. 37.7%, respectively; P<0.05). The VRS-6 score in group M+D was 1.4 (range 0-4), whereas the corresponding score in group D was 2.4 (range 1-6). Mean (OAA/S) score in group M+D was lower than in the group D (1.5±0.3 vs. 3.3±0.4, respectively; P<0.05). Duration of sedation in group M+D was significantly longer than the corresponding mean for group D (22.5±6.4 vs. 12.1±3.3min, respectively; P<0.01). The first postoperative analgesic request after surgery was 120min in group M+D and 60min in group D (P<0.05). Midazolam enhances the postoperative analgesic effects of diclofenac when used before the onset of noxious stimuli.