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Background and Aim:Different adjuncts have been utilized to promote the quality and prolong the duration of local anesthetics for a variety of regional block techniques. This study aimed to assess the effects of midazolam coadministered with bupivacaine in transversus abdominis plane (TAP) block on the 24-h morphine consumption, the postoperative analgesia duration and adverse effects.Settings and Design:A prospective, randomized, controlled double-blind trial that was carried out at a university hospital.Patients and Methods:Eighty-two females subjected to open total abdominal hysterectomy under general anesthesia were involved in this trial. Participants were allocated randomly to either of two groups (41 each). Control group: received TAP block with 20 mL of 0.25% bupivacaine or midazolam group: received TAP block using the same volume of bupivacaine plus 50 μg/kg midazolam/side. Postoperative cumulative 24-h morphine consumption, analgesia duration, pain score, sedation score, and adverse events were recorded.Statistical Analysis:Student's t-test, Mann–Whitney U-test, and Chi-square test were used.Results:Patients in the midazolam group had a lower cumulative 24-h morphine consumption [median doses (interquartile range): 15 (10–19.50) mg compared to 25 (17.50–37) mg, P < 0.001], lower postoperative pain score at rest at the 4th, 6th, and 12th h (P = 0.01, 0.02, and 0.02, respectively) and on movement at 2, 4, 6, and 12 h (P < 0.001), longer time till the first postoperative demand for rescue analgesia (430.11 ± 63.02 min) compared to 327.78 ± 61.99 min (P < 0.001), and less sedation, nausea and/or vomiting, and pruritus.Conclusions:Adding midazolam as a bupivacaine adjuvant for TAP block reduces the 24-h morphine consumption, extends the postoperative analgesia duration, and decreases the incidence of adverse effects following abdominal hysterectomy.

Introduction: Intrathecal fentanyl is routinely mixed with hyperbaric bupivacaine during spinal block, but this may alter the baricity of both drugs and hence affect their spread and action. Aim: This study aimed to compare the sequential administration of intrathecal fentanyl and bupivacaine to the routine mixing of the two drugs as regard the block characteristics, the postoperative analgesia duration, and the adverse effects. Methods: Current prospective, controlled, randomized trial was carried out on 100 adult participants subjected to lower limb orthopedic surgeries under spinal anesthesia. Subjects were allocated randomly into two equal groups (50 each). Group P: received premixed solution of hyperbaric bupivacaine (HB) 0.5 % (12.5 mg) plus 25 µg of fentanyl in the same syringe and group S: received 25 µg of fentanyl followed by 12.5 mg of HB in sequential manner. Block characteristics, time to the first rescue pethidine request, number of participants who requested for pethidine within the first 6 postoperative hours, and adverse effects were assessed. Results: Group S patients had statistically significantly faster onset of both sensory (4.58 ± 1.5 vs 5. 40 ± 1.8 min, p = 0.02) and motor block (5.79 ± 1.5 min versus 6.64 ± 1.9 min, p = 0.01), shorter time to achieve the highest sensory level (6.12 ± 1.96 min vs 8.77 ± 2.5min, p = 0.00), and a longer time till the first postoperative rescue analgesic need (252.26 ± 39.3 min versus 234.70 ± 40.2 min, p = 0.03). Group P patients achieved statistically significantly higher level of sensory blockade and showed longer sensory block duration (216.30 ±30.8 vs 199.44± 23.8, p = 0.003). Adverse effects were comparable in both groups. Conclusions: The sequential administration of fentanyl and hyperbaric bupivacaine improves the spinal block characters in patients subjected to lower limb orthopedic surgeries with comparable adverse effects profile in comparison to mixing both drugs.