Comparison of the effect of adding midazolam versus fentanyl to intrathecal levobupivacaine in patients undergoing cesarean section: double-blind, randomized clinical trial

AbdelRady, Marwa Mahmoud; Fathy, Golnar Mohammed; Abdallah, Mohamed Abdelrady Mohamed; Ali, Wesam Nashat

doi:10.1016/j.bjane.2022.06.001

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…On the other hand, Abdelrady et al [19] reported that median the VAS scores were lesser in midazolam than fentanyl groups.…”

Section: Discussionmentioning

confidence: 95%

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

Nayak¹,

Ninave²,

Tayade³

et al. 2023

Cureus

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Background The administration of adequate analgesia post-operatively has been associated with fewer cardiopulmonary complications, lower morbidity and mortality, lower healthcare costs, and higher patient satisfaction. One of the most effective ways to raise the standard of healthcare would be standardization of multimodal analgesia with enhanced recovery after surgery. Adjuncts to spinal anesthetists can achieve a better post-operative pain relief with less doses of rescue analgesia. Methods This was a prospective, randomized trial conducted on 60 women undergoing abdominal hysterectomy under spinal anesthesia. We evaluated the impact of adding 0.5 mL (2.5 mg) of intrathecal midazolam versus 25 mcg of intrathecal fentanyl (0.5 mL) with 2.5 mL injection of 0.5% bupivacaine (hyperbaric) (12.5 mg). The outcomes were prolongation of analgesia in the post-operative period, onset and duration of sensory and motor blockade, stable hemodynamics, and any adverse reactions to the study drugs. Results The two groups, group M (midazolam + hyperbaric bupivacaine) and group F (fentanyl + hyperbaric bupivacaine), had similar distribution for age, weight, and type and duration of surgical procedure. Both groups had stable vital parameters and experienced a similar onset of sensory and motor blockade. Intraoperative modified Ramsay sedation score was better in group M in comparison to group F. However, mean of elapsed time of two-segment regression of sensory block, from T12 to L1 level, and mean time to regression, from Bromage score 3 to 2, were longer in group F. Group F also had a better visual analogue scale (VAS) score in the post-operative period than group M, and group F experienced a longer average post-operative analgesic duration (lasting for 367.73 minutes) as compared to group M (lasting for 254.9 minutes), having a difference that was of statistical significance (p < 0.001). No substantial adverse reactions were seen in either group. Conclusion The duration of post-operative analgesia is significantly prolonged when 25 mcg of adjuvant intrathecal fentanyl is used with 0.5% bupivacaine (hyperbaric) as compared to intrathecal midazolam 0.5 mL (2.5 mg) in women undergoing abdominal hysterectomy under spinal anesthesia. Both fentanyl and midazolam have minimal adverse reactions and are safe to use as adjuvants to 0.5% of bupivacaine (hyperbaric) in surgeries conducted in the lower abdomen.

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“…On the other hand, Abdelrady et al [19] reported that median the VAS scores were lesser in midazolam than fentanyl groups.…”

Section: Discussionmentioning

confidence: 95%

“…However, Modir et al [ 13 ] found that there is no suggestive difference in group M and group F regarding post-operative pain. On the other hand, Abdelrady et al [ 19 ] reported that median the VAS scores were lesser in midazolam than fentanyl groups.…”

Section: Discussionmentioning

confidence: 99%

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

Nayak¹,

Ninave²,

Tayade³

et al. 2023

Cureus

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Comparative Analysis of Low-Dose Levobupivacaine and Low-Dose Bupivacaine with Fentanyl for Spinal Anesthesia in Cesarean Sections: A Focus on Duration of Analgesia and Hemodynamic Stability

Dhulkhed,

Patil,

Tiptur

2024

2024 International Conference on Healthcare Innovations, Software and Engineering Technologies (HISET)

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A Comparative Study of the Effects of Intrathecal Midazolam(1mg) and Fentanyl(25 Micrograms) as Additives to Intrathecal Hyperbaric Bupivacaine 0.5%(15MG) in Spinalanaesthesia

Majumdar

Gangadhar

Ramesh

et al. 2022

ijsr

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Background: Various intrathecal additives are added to local anesthetics to increase the speed of onset, improve the quality, and prolong the inuence of spinal anesthesia. Midazolam has a synergistic effect on postoperative analgesia when administered intrathecally with bupivacaine. Opioids such as fentanyl are extensively used as an adjunct to local anesthetics in neuraxial blockade to enhance the duration of postoperative analgesia. Aim: The aim of our study was to compare the effects of intrathecal midazolam(1mg) and fentanyl (25 micrograms) as additives to intrathecal hyperbaric bupivacaine 0.5% (15mg) with spinal anesthesia.Materials and Methods: Prospective, observational study was conducted at SRI SIDDHARTHAMEDICAL COLLEGE AND RESEARCH INSTITUTE,TUMKUR. from 1st Jan 2021 to 30th June 2022 on 94 patients. Results: In Bupivacaine and Midazolam group, mean duration of surgery was 84 ± 12.3 minutes and in Bupivacaine and Fentanyl group, mean duration of surgery was 92 ± 14.4 minutes. In Bupivacaine and Midazolam group, mean time for onset of sensory block was 7.1 ± 0.9 minutes and in Bupivacaine and Fentanyl group, mean time for onset of sensory block was 6.9 ± 1.1 minutes. In Bupivacaine and Midazolam group, mean time for onset of motor block was 7.6 ± 1.3 minutes and in Bupivacaine and Fentanyl group, mean time for onset of motor block was 8.1± 1.2 minutes. In Bupivacaine and Midazolam group, mean duration of sensory block was 213.6 ± 16.1 minutes and in Bupivacaine and Fentanyl group, mean duration of sensory block was 218.3 ± 19.2 minutes. Conclusion- The onset of sensory and motor blockade was comparable in Fentanyl with Bupivacaine and Midazolam with Bupivacaine. Additional of intrathecal Fentanyl prolonged the duration of analgesia signicantly than that of Midazolam. There was signicantly less consumption of rescue of analgesia among patients with Fentanyl with Bupivacaine than Midazolam with Bupivacaine. The duration of postoperative analgesia was also signicantly prolonged in the fentanyl and midazolam groups

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Comparison of the effect of adding midazolam versus fentanyl to intrathecal levobupivacaine in patients undergoing cesarean section: double-blind, randomized clinical trial

Cited by 3 publications

References 21 publications

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

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

Comparative Analysis of Low-Dose Levobupivacaine and Low-Dose Bupivacaine with Fentanyl for Spinal Anesthesia in Cesarean Sections: A Focus on Duration of Analgesia and Hemodynamic Stability

A Comparative Study of the Effects of Intrathecal Midazolam(1mg) and Fentanyl(25 Micrograms) as Additives to Intrathecal Hyperbaric Bupivacaine 0.5%(15MG) in Spinalanaesthesia

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