A Study to Compare the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam Combination in Patients Undergoing Elective Infraumbilical Surgery

Chattopadhyay, Anirban; Maitra, Souvik; Sen, Suvadeep; Bhattacharjee, Sulagna; Layek, Amitava; Pal, Shweta; Ghosh, Kartick Chandra

doi:10.1155/2013/567134

Cited by 22 publications

(20 citation statements)

References 17 publications

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“…Although previous studies 12,14,24 have reported a decreased incidence of PONV with the use of intrathecal midazolam, we did not find any significant difference in PONV among groups. This may be because our study was not adequately powered for PONV.…”

Section: Discussioncontrasting

confidence: 99%

“…Others also observed that intrathecal midazolam produced significant postoperative pain relief in patients undergoing lower abdominal and perineal surgeries. 12,13,15,17 Midazolam produces spinally mediated analgesia that is different in quality from that produced by the μ-opioid agonist fentanyl. The analgesic effects of intrathecal midazolam have been proposed to be due to its intrathecal spinal receptor interactions affecting the type A gamma-aminobutyric acid receptors.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10] Previous reports have shown that administration of intrathecal midazolam with local anesthetics prolongs the duration of spinal anesthesia and produces longer postoperative analgesia after lower abdominal and perianal surgeries. [11][12][13][14][15][16][17] None of these studies reported any serious adverse effects in patients receiving intrathecal midazolam. A large cohort study investigating the adverse neurological effects of intrathecal midazolam has also found no association between intrathecal midazolam and neurologic symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of intrathecal midazolam versus fentanyl for endoscopic urology surgery

Bharti

Batra

Negi

2015

Southern African Journal of Anaesthesia and Analgesia

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Background: This prospective randomized double-blind study was designed to compare the analgesic efficacy and safety of intrathecal midazolam versus fentanyl as an adjunct to bupivacaine for endoscopic urology surgery. Methods: Sixty adult ASA grade I-II patients undergoing transurethral resection of prostate or bladder tumor under spinal anesthesia were randomly allocated into three groups. Group B (control group) received 2 ml 0.5% hyperbaric bupivacaine while group BM received midazolam 2 mg and group BF received fentanyl 25 μg along with 2 ml of 0.5% bupivacaine in subarachnoid block. Postoperative analgesia was provided with intravenous diclofenac. The onset and duration of sensory and motor blockade, postoperative pain and the time to 1st rescue analgesia was noted. Patients were observed for hypotension, bradycardia, sedation, respiratory depression, pruritus, and postoperative nausea-vomiting. Results:The onset times and the duration of motor blockade were comparable among groups while the time to sensory block regression was longer in group BM and group BF as compared to group B (p < 0.001).The duration of postoperative analgesia was significantly prolonged in group BM and group BF as compared with group B (p < 0.001) while there was no difference between group BM and BF. The incidence of pruritus and vomiting was more in group BF. Conclusions: Addition of midazolam to intrathecal bupivacaine provides prolonged postoperative analgesia similar to intrathecal fentanyl and appears safe in patients undergoing endoscopic urology surgery.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of intrathecal midazolam versus fentanyl for endoscopic urology surgery

Bharti

Batra

Negi

2015

Southern African Journal of Anaesthesia and Analgesia

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“…2,[11][12][13][14] The duration of analgesia in the test group was increased by 85 minutes in the study by Akhtaruzzaman et al and by 87 minutes in the study by Sidiq et al The study by Chattopadhyay et al was also done for lower abdominal surgeries like ours, but they used larger dose of anaesthetics (12.5 mg bupivacaine and 2 mg midazolam) and so achieved longer duration of analgesia (100 minutes) in test group compared to our study. 15 No difference in sedation levels was found in the two groups, similar to studies by Prakash et al and Shadangi et al 16,17 There was no difference between both the groups with respect to quality of anaesthesia unlike studies by Vasanthi et al and Akhtaruzzaman et al who observed better quality anaesthesia in test group. Also, incidence of side effects viz.…”

Section: Resultssupporting

confidence: 76%

A Study of Intrathecal Bupivacaine and Bupivacaine With Midazolam in Lower Abdominal Surgeries

Deka¹,

Abraham²,

Mallikarjun³

et al. 2018

jemds

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BACKGROUND Several adjuvants have been tried along with local anaesthetic in spinal anaesthesia for prolonging the duration of analgesia . Intrathecal midazolam produces anti-nociception and potentiates the effect of local anaesthetics. The aim of this study is to study the comparison between intrathecal bupivacaine and bupivacaine with midazolam with spinal anaesthesia. MATERIALS AND METHODSThis is a comparative, randomised, double-blinded study of 90 patients within the age group of 18 -60 years with ASA status I or II, undergoing various lower abdominal surgical procedures. They were randomly allocated to one of the two groups, each containing 45 patients as follows: The B group receiving 2 mL of 0.5% hyperbaric bupivacaine (10 mg) and 1 mL of 0.9% saline intrathecally; the BM group receiving 2 mL of 0.5% hyperbaric bupivacaine (10 mg) with 1 mL (1 mg) of preservative-free midazolam. The onset, duration of sensory/ motor block, the time to achieve maximum sensory block and the level of block, time for first rescue analgesia, sedation score, quality of anaesthesia and side effects were noted. RESULTSThere was no significant difference in the demographic distribution of the patients. There was no statistically significant difference in the onset of the sensory block (p-value > 0.05) and time to achieve maximum level of sensory block in both groups (p-value > 0.05). Mean duration of sensory block or effective analgesia in group BM was 330.88 ± 16.36 minutes, while that in group B was 273.68 ± 15.69 minutes, which was statistically significant (p-value < 0.05). There was no statistically significant difference between both the groups with respect to motor block and quality of anaesthesia. The sedation score was comparable in both groups. The side effect profiles in both groups were also comparable. CONCLUSIONThe addition of 1 mg preservative-free midazolam to 0.5% hyperbaric bupivacaine prolongs the duration of effective analgesia as compared to bupivacaine alone and delays the need for postoperative rescue analgesics without affecting the onset of block and without increasing the risk of side effects. Spinal anaesthesia with bupivacaine is routinely administered for lower abdominal surgeries with adequate motor blockage, additionally providing effective pain relief in the initial post-operative period due to its long duration of action. 1 However, the Cardiovascular Collapse/ Central Nervous System (CC/CNS) ratio of bupivacaine is narrow (2.7) with a higher propensity of irreversible cardiovascular collapse. 1 'Financial or Other Competing Interest': None. Submission 22-11-2017, Peer Review 16-12-2017, Acceptance 22-12-2017, Published 08-01-2018. Corresponding Author: Dr. Partha Pratim Deka, Meridiyen Apartments, Apt. No. 409, Deralakatte, Yenepoya Medical College, Mangalore-575018, Karnataka, India. E-mail: dr.parthadeka@live.in DOI: 10.14260/jemds/2018 Therefore, in order to minimise the dose of bupivacaine and to reduce its side effects the use of an adjuvant that would prolong its duration...

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“…8 The most common side effects with the use of opioids include pruritis, respiratory depression, nausea, vomiting, urine retention and sedation. 9 Various animal studies have also been conducted to confirm that Nalbuphine was not neurotoxic. Rawal et al in a sheep model showed that even large doses of 15-24 mg of napbuphine were not associated with hypertensive changes in spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Efficiency of nalbuphine as an adjuvant to bupivancaine in lower limb orthopaedic surgery-a prospective study

Gupta¹,

Gupta²,

Neeraj

2017

Int J Res Med Sci

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INTRODUCTIONSpinal anaesthesia is a well embraced technique for performing lower limb orthopaedic surgeries. It is simpler to perform with rapid onset of action and profound muscle relaxation. Spinal anaesthesia allows for lower drug dosage and lower incidence of failed block.1,2 Every coin has two sides. Spinal anaesthesia has a shorter duration of action and early arising postoperative pain due to which various adjuvant need to be added and their roles are being evaluated in various studies. Intrathecal administration of adjuvant drugs to local anaesthesia improves quality and duration of spinal blockage and also prolongs postoperative analgesia. Moreover, the dose and amount of local anaesthetic drugs are also reduced during subarachnoid block. 3Intrathecal opioids act synergistically with local anesthetics and thus intensifying the sensory block without having any effect ABSTRACT Background: Spinal Anaesthesia is a well-known technique of performing lower limb orthopaedic surgeries. It has a shorter duration of action and early arising postoperative pain due to which various adjuvant needs to be added and their roles are being evaluated in various studies. Intrathecal opioids act synergistically with local anaesthetics and thus intensifying the sensory block without having any effect on sympathetic blockage. The main aim of present study is to investigate and evaluate the effectiveness of intrathecal nalbuphine (preservative free) as an adjuvant and also the efficacy of nalbuphine for postoperative analgesia and its complications if there are any. Methods: A total of 60 patients were included in this study belonging to ASA I and ASA II score with normal coagulation profile. Patients were randomly divided into 2 groups of 30 patients each. Group I receiving 3 ml of hyperbaric bupivacaine 0.5%+1.0mgm of nalbuphine (preservative free) injection made in 0.5 ml normal saline intrathecally. Group II received 3 ml of hyperbaric bupivacaine 0.5%+0.5 ml injection Normal saline intrathecally. The following criteria were noted. The onset of sensory blockade and complete motor blockade highest level of sensory blockade, duration of sensory blockade, duration of motor and duration of effective analgesia were recorded. Any hemodynamic alterations were also noted. Results: The mean time for the onset of sensory blockage was 56 sec in Group I and 59 sec in Group II (control). The difference were statistically insignificant (p>0.05). The mean onset of motor blockage was 106 sec in Group I and 208 sec in Group II (control). The difference was statically insignificant. The peak onset time in Group I and Group II was 372 sec and 220 sec respectively (p>0.05). Two segment regression times for sensory blockage was prolonged in Group I (118.20±8.56 min) compared to Group II (104.56±15.20 mins). Conclusions: The duration of postoperative analgesia was 6-8 hours in Group I compared to 3-4 hours in Group II (p value= 0.0001, statistically significant).

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A Study to Compare the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam Combination in Patients Undergoing Elective Infraumbilical Surgery

Cited by 22 publications

References 17 publications

Efficacy of intrathecal midazolam versus fentanyl for endoscopic urology surgery

Efficacy of intrathecal midazolam versus fentanyl for endoscopic urology surgery

A Study of Intrathecal Bupivacaine and Bupivacaine With Midazolam in Lower Abdominal Surgeries

Efficiency of nalbuphine as an adjuvant to bupivancaine in lower limb orthopaedic surgery-a prospective study

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