Comparison of Intrathecal Midazolam and Fentanyl used as an adjuvant with Hyperbaric Bupivacaine in infraumbilical surgeries: A prospective, randomized, double-blind, interventional study
Abstract
Post-operative pain management remains a challenge. Various combination of medicines are used to reduce post operative pain. So study was designed to compare the effect of Midazolam and Fentanyl adjuvant to Bupivacaine in reducing pain in infra-umblical surgeries It was observed in thia study that duration of analgesia was 197.6±9.8 minutes when bupivacaine was used alone, while it increased to 272.8±10.9, and 286±10.4 minutes when bupivacaine was used in combination with fentanyl and midazolam respectively. The total duration of analgesia in midazolam group was significantly more than Fenetanyl and Saline group. Present study demonstrated that midazolam produce longer duration of post-operative analgesia when compared to fentanyl. Mean VAS scores at various intervals were compared in all the three groups, it was found without significant variation till 2 hours of surgery but after that upto 3 hours it was minimum (<0.05) in Midozolam group and after 3 hours it significantly less (<0.05) in Fenetanyl group. So it can be concluded from this study that adding Midozolam with Bupivacaine is good for analgesia.
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Introduction
Post-operative pain management remains a challenge despite recent advances in our understanding of the physiology of acute pain, the newly developed opioid and non-opioid analgesics , novel methods of drug delivery (systemic, regional and local) and more widespread use of interventional pain managment.1
The concept of multimodal “opioid-sparing” analgesic techniques (so-called balanced analgesia) was introduced more than 15 years ago2 with the aim of improving analgesia by combining analgesics with additive or synergistic effects. Midazolam is potent short acting, water soluble benzodiazepine, which has been used for potentiating the analgesic effect of local anesthetic induced neuraxialsblockade.3 Its use as postoperative analgesic by intrathecal route was first studied by Valentine J.M, Lyon.3 Spinal analgesic effect of midazolam is mediated by benzodiazepine-GABA receptor complex within the spinal cord. GABA receptors are abundant in dorsal root nerve cells and maximum concentration found in lamina-II of dorsal horn ganglia.4,5,6 Intrathecal Midazolam also has anti-nociceptive effect mediated via spinal opiate receptors.5 Midazolam, despite of being the commonest benzodiazepine used in anesthesia and preoperative care, is a relatively newer addition to the list of adjuvant used in subarachnoid block. Addition of intrathecal midazolam to bupivacaine significantly improves the duration and quality of spinal anesthesia and provides prolonged preoperative analgesia without any significant side effects.
Conclusion
It can be concluded from this present study that duration of analgesia in midazolam group was significantly more than other Fenetanyl and Saline group. Present study concludes that midazolam produce longer duration of post-operative analgesia when compared to fentanyl.