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

Abstract

Objective: The objective was to compare analgesic effect of combined epidural morphine-midazolam with either drug alone on postoperative pain in patients undergoing major abdominal cancer surgery. Materials and Methods: Eighty-four patients were allocated in prospective randomized double-blind study to receive epidural analgesia. Patients received 5 mg morphine in morphine (Mor) group, 5 mg midazolam in midazolam (Mid) group, 5 mg morphine + 5 mg midazolam in morphine-midazolam (MM) group, 0.25% bupivacaine was added to injected solution with same volume in all groups. All groups were compared with time of first analgesic request, total analgesic consumption, number of epidural doses, postoperative Visual Analog Scale score, and adverse events. Results: Time of first analgesic request was 4 to 8 hours in Mid versus 12 to 23 and 14 to 24 hours in Mor and MM groups, respectively, with significant difference between Mid versus Mor (P<0.001), Mid versus MM (P<0.001), and Mor versus MM groups (P<0.031). Analgesic consumption was more in Mid than Mor and MM groups, with significant difference between Mid versus Mor (P<0.008), Mid versus MM (P<0.001), with no significant difference between Mor and MM groups (P<0.6). The number of epidural doses in Mid was 1 to 3 versus 1 to 3, and 1 to 2 in Mor and MM groups, respectively, with significant difference between Mid versus Mor (P<0.025), Mid versus MM (P<0.004), with no significant difference between Mor and MM groups (P=1.0). Conclusions: Addition of midazolam to epidural morphine prolonged time of first analgesic request and decreased total analgesic consumption.

Efficacy and safety of different doses of epidural morphine coadministered with low-concentration ropivacaine after cesarean section: A retrospective cohort study

“…Due to its high degree of hydrophilic properties, epidural morphine could provide more effective analgesia with slow onset and longer duration, and thus has been frequently used in different clinical scenarios ( Mercanoğlu et al, 2013 ; Meng et al, 2019 ; Yang et al, 2019 ; Abdelemam et al, 2022 ). However, the aforementioned opioid-related adverse events remain evitable.…”

Comparative study of intrathecal fentanyl and midazolam for postoperative pain relief after lower abdominal surgery

“…Midazolam may be used as a perfect epidural and intrathecal analgesic for persistent postoperative pain because of its widespread availability and good patient tolerance. Midazolam had been proved to potentiate the analgesic effect of local anesthetics when added to it in both central neuraxial (intrathecal, epidural, and caudal) and peripheral nerve blocks techniques [2] . Opioids like fentanyl have been shown in some studies to enhance the quality of subarachnoid block when added to hyperbaric bupivacaine; however, there are drawbacks to using opioids in local anesthetic solutions, including pruritus and respiratory depression [3] .…”