Comparative study of intrathecal fentanyl with bupivacaine and fentanyl midazolam with bupivacaine in spinal anaesthesia

Abstract

Spinal anaesthesia is preferred for lower abdominal and lower limb surgeries. Bupivacaine is the most popular local anaesthetic for subarachnoid blockade because of less neurotoxicity. Intrathecal bupivacaine alone may be insufficient to provide prolonged post-operative analgesia, even with high sensory block. So, various adjuvants are used like ketamine, midazolam, clonidine, opioids, neostigmine etc. to prolong the effect of local anaesthetic.To compare the effect of intrathecal fentanyl and fentanyl-midazolam combination with hyperbaric bupivacaine for quality of anaesthesia and post-operative analgesia.Study was conducted on 60 patients aged 20-60 years and were randomly divided into two groups of 30 patients each. Group A received 0.5% bupivacaine heavy 3 ml (15mg) + fentanyl 0.5 ml (25µg) and Group B 0.5% bupivacaine heavy 2.8 ml (14mg) +fentanyl 0.5 ml (25 µg) + midazolam 0.2 ml (1mg). Total volume is 3.5 ml in both groups. They were assessed for quality of block, post-operative analgesia and perioperative complications.Data were compared using t- test(unpaired). The level of significance used was p<0.05. There was a significant difference in onset and duration of sensory and motor block, time to administer first rescue analgesia in group B. Addition of midazolam (1mg) to fentanyl with bupivacaine intrathecally gives better onset & duration of sensory & motor blockade and longer duration of post-operative analgesia.

Intrathecal Adjuvant Midazolam Versus Fentanyl With Hyperbaric Bupivacaine for Post-operative Analgesia in Women Undergoing Total Abdominal Hysterectomy

“…There was no meaningful dissimilarity in the onset of motor blockade in both the groups (p = 0.19), and similar findings have been reported by Mehta et al [ 11 ], Panwar et al [ 9 ], and Yektas [ 12 ].…”

“…Motor blockade at different points in times after the procedure was comparable in both the groups, with similar observations by Mehta et al [ 11 ], Panwar et al [ 9 ], and Yektas [ 12 ]. Median sensory-motor blockade achieved by fentanyl and midazolam as adjuvants remain similar, as the opioid receptors are as abundant as GABA receptors in the spinal cord.…”

“…Modir et al [ 13 ] reported that midazolam shows a shorter time to onset of sensory blockade after spinal anesthetic (5.20±0.72), whereas fentanyl took 8.42±0.65 minutes. Similar findings of early sensory blockade with intrathecal midazolam have been reported by Mehta et al [ 11 ], Panwar and Chittora [ 9 ], and Yektas [ 12 ]. In similarity, finding of early onset of sensory blockade was observed by Codero et al [ 14 ] when midazolam was co-administered with bupivacaine.…”

“…Similar findings were noted by Bhure et al [ 10 ] when analyzing and contrasting fentanyl and midazolam as additives to 0.5% bupivacaine (hyperbaric). Mehta et al [ 11 ] reported that BZDs cause a segmental block of nociceptives without having any negative affection of the heart, lungs, or nervous system. Findings of the present study are also corroborated by Yektas [ 12 ], Mehta et al [ 11 ], and Modir et al [ 13 ].…”

“…Mehta et al [ 11 ] reported that BZDs cause a segmental block of nociceptives without having any negative affection of the heart, lungs, or nervous system. Findings of the present study are also corroborated by Yektas [ 12 ], Mehta et al [ 11 ], and Modir et al [ 13 ]. Both fentanyl and midazolam do not affect the vital parameters exceptionally when given intrathecally as adjuvants; however, preloading with adequate fluids should be assured.…”