A comparison of epidural analgesia provided by Bupivacaine plus Pethidine, Bupivacaine plus Morphine, or Bupivacaine plus Morphine plus Midazolam for lower limb orthopaedic surgery

Abstract

Background: Epidural anaesthesia and analgesia in orthopaedic surgeries helps to prevent thromboembolic phenomenon by increasing venodynamics. Adequate post-operative analgesia with good patient satisfaction has been observed with this technique. Objective:To assess the duration of postoperative analgesia and complications in patients receiving epidural anaesthesia with Morphine, Midazolam and Pethidine in combination with Bupivacaine. Methods:We prospectively studied 75 patients who were scheduled for elective lower limb orthopaedic surgery with epidural anaesthesia at Lumbini Medical College, Palpa from 2010 March to 2012 March. They were randomly divided by lottery method into three equal groups. Group 'A' (BP) received 50 mg epidural Pethidine (3 ml) with 13 ml of 0.5% Bupivacaine. Group 'B' (BM) received 5 mg (3 ml) epidural Morphine with 13 ml of 0.5% Bupivacaine and Group 'C' (BMM) received 5 mg (1 ml) epidural Morphine with 13 ml 0.5% Bupivacaine and 2 mg (2 ml) epidural Midazolam.All the patients were observed for 24 hours for quality of analgesia and other side effects like nausea, vomiting and pruritus. Data were analysed by Statistical Package for Social Sciences (SPSS-16) software. Results:The result of the study shows the duration of analgesia was prolonged in BM group than BP group and even more so in BMM group (p value <0.001). Incidence of nausea and vomiting in BMM group was lower than in BP and BM group but statistically the difference was not significant (p value: 0.489). Pruritus was absent in BP group, less in BMM group while significantly higher in BM group. Conclusion:The use of epidural Morphine and Midazolam in combination with Bupivacaine is the satisfactory method of post operative analgesia. When Midazolam is added, duration of analgesia can be increased with decrease in incidence of nausea, vomiting and pruritus. METHODSWe prospectively studied 75 8. Weissman C. The metabolic response to stress:An overview and update. Anesthesiology. 1990;73:308-27. 9. Kehlet H. The stress response to surgery: Release mechanisms and the modifying effect of pain relief.

Effect of Combined Epidural Morphine and Midazolam on Postoperative Pain in Patients Undergoing Major Abdominal Cancer Surgery

“…Epidural morphine had better effect in terms of postponing the time to first analgesic request and diminishing the dose of rescue analgesia in contrast to epidural midazolam. This finding in accordance with the study by Sharma and Timalsena, 19 on patients who were scheduled for elective lower limb orthopedic surgery with epidural anesthesia to determine postoperative analgesia and its side effects, showed that epidural midazolam is more reliable and satisfactory for postoperative pain management when used in combination with morphine and bupivacaine in adults. Also, revealed that the use of midazolam in combination with morphine and bupivacaine has reduced the incidence of morphine-induced side effects like nausea and vomiting than morphine and bupivacaine group, but statistically, it was not significant.…”

“…Software 18. On the basis of pervious study,19 we expected to find large effect size between the 3 groups (effect size=0.40) when using (analysis of variance ANOVA) test. With the power of 90% and α of 0.05, the sample needed for the study was estimated to be 84 patients 28 patients in each group).…”