Intrathecal Midazolam as an Adjuvant in Pregnancy-Induced Hypertensive Patients Undergoing an Elective Caesarean Section: A Clinical Comparative Study

Dodawad, Ravichandra; Sumalatha, Gangur Basappa; Pandarpurkar, Sandeep; Jajee, Parashuram

doi:10.5812/aapm.48854

Cited by 8 publications

(8 citation statements)

References 35 publications

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“…The use of intrathecal midazolam was evaluated in several studies [63,64]. A comparative study demonstrated that intrathecal magnesium and intrathecal sufentanil were superior to intrathecal midazolam [63].…”

Section: Neuraxial Adjuvant Drugsmentioning

confidence: 99%

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PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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Caesarean section is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and patient satisfaction as well as breastfeeding success and mother-child bonding. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language between 1 May 2014 and 22 October 2020 evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane databases. Studies evaluating pain management for emergency or unplanned operative deliveries or caesarean section performed under general anaesthesia were excluded. A total of 145 studies met the inclusion criteria. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, recommendations include intrathecal morphine 50-100 µg or diamorphine 300 µg administered pre-operatively; paracetamol; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone administered after delivery. If intrathecal opioid was not administered, single-injection local anaesthetic wound infiltration; continuous wound local anaesthetic infusion; and/or fascial plane blocks such as transversus abdominis plane or quadratus lumborum blocks are recommended. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs with opioids used for rescue. The surgical technique should include a Joel-Cohen incision; non-closure of the peritoneum; and abdominal binders. Transcutaneous electrical nerve stimulation could be used as analgesic adjunct. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations. Some interventions were not recommended due to insufficient, inconsistent or lack of evidence. Of note, these recommendations may not be applicable to unplanned deliveries or caesarean section performed under general anaesthesia.

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Section: Neuraxial Adjuvant Drugsmentioning

confidence: 99%

“…A comparative study demonstrated that intrathecal magnesium and intrathecal sufentanil were superior to intrathecal midazolam [63]. Intrathecal midazolam prolonged the duration of spinal anaesthesia when compared with placebo [64]. Intrathecal ketamine prolonged analgesia when compared with fentanyl [65,66].…”

Section: Neuraxial Adjuvant Drugsmentioning

confidence: 99%

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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“…It was revealed by the results of the current studies that low dose midazolam intrathecally had no detectable adverse impact on neonatal condition, which are in concordance with the results of other investigators. 17,19,20…”

Section: Resultsmentioning

confidence: 99%

Intrathecal midazolam for prevention of nausea and vomiting during and after cesarean section under spinal anaesthesia

2020

IJCA

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Introduction: Relevant incidences of nausea-vomiting during and immediately after cesarean section in spinal anesthesia are found to be high. Effectiveness of intrathecal midazolam (2 mg) as an adjuvant to bupivacaine on the incidence and severity of intraoperative and immediate postoperative nausea and vomiting was investigated in the present study. Materials and Methods: A randomized, controlled, double-blind study was conducted in 120 healthy women (ASA Physical status I and II) scheduled for elective cesarean section under spinal anesthesia. Parturients were randomly divided into two equal groups of 60 each. Group M(study group)-Patients received 10 mg (2.0ml) of 0.5% hyperbaric bupivacaine combined with 2 mg (0.4 ml) midazolam intrathecally and Group C (control group)-10 mg (2.0ml) of 0.5% hyperbaric bupivacaine combined with 0.4 ml normal saline intrathecally. Assessment of the patients were done for incidence of nausea-vomiting, hemodynamic effects and occurrence of adverse effects during cesarean section and during first 6 hours after the operation. Results: Incidence of emetic symptoms in Group M were significantly lower than Group C (15% vs 63.34%, p< 0.05). There were no clinically serious adverse events observed in any of the groups. All neonates had APGAR scores more than 8 at one and five minutes. Conclusion: Intrathecal midazolam as an adjuvant to Bupivacaine is associated with lower incidence of nausea and vomiting with no neonatal adverse effects.

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“…As regards midazolam, Dodawad et al (17) reported that postoperative analgesia was significantly better and longer in the midazolam group as demonstrated by its significantly longer time until the first request for analgesia and also the lower need for rescue analgesics.…”

Section: Peritoneal Traction and Handling Of Intraperitoneal Organs During Cesarean Delivery Lead To Intraoperative Visceral Painmentioning

confidence: 99%

Comparative Study Between Intrathecal Fentanyl and Midazolam as Adjuvant to Local Anesthetics in Spinal Anesthesia in Elective Cesearean Section in Post-Operative Anesthesia and Post-Operative Analgesia

Fawaz

Elie

Abdelwahab

et al. 2020

Ain Shams Medical Journal

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Background: Subarachnoid block achieved a wide spread popularity as a simple and effective method of anesthesia for elective cesarean sections. Among the local anesthetics, bupivacaine is the most commonly used drug for subarachnoid block. Aim of the Work:This study was conducted to evaluate and compare the effects of intrathecal midazolam and fentanyl as additives to intrathecal hyperbaric bupivacaine with regards to onset and duration of sensory block, duration of complete and effective analgesia and side effects associated with the drug. Patients and Methods: This study included 90 women aged between 18-35 years scheduled to undergo elective cesarean section under spinal anesthesia. Patients were subdivided randomly into 3 groups (30 patients each) on the basis of the adjuvant added to the anesthetic used; group A (Fentanyl + bupivacaine), group B (Midazolam + bupivacaine) and group C (Bupivacaine).Results: Demographic data did not differ between the three study groups (p > 0.05). Group A showed a significantly earlier onset of sensory block (p =0.005), motor block (p = 0.009), as well as late regression to L1 sensory level (p <0.001). Additionally, longer analgesia (p < 0.05) and longer time before the first call for analgesics (p = 0.005) was associated with group A. The required dose of paracetamol and pethidine within the first day were significantly lower in group A and group B in comparison to group C. However, complications encountered did not differ between the three study groups (p > 0.05). Also, the state of the neonates didn't show significant difference between the three groups. Conclusion:Intrathecal adjuvants are associated with improving out comes after CS as revealed by delayed onset and longer duration of sensory and motor block in addition to longer duration of complete and effective analgesia. Intrathecal fentanyl revealed better outcomes in terms of delayed onset and longer duration of sensory and motor block in addition to longer duration of complete and effective analgesia as compared with midazolam.

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Intrathecal Midazolam as an Adjuvant in Pregnancy-Induced Hypertensive Patients Undergoing an Elective Caesarean Section: A Clinical Comparative Study

Cited by 8 publications

References 35 publications

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

Intrathecal midazolam for prevention of nausea and vomiting during and after cesarean section under spinal anaesthesia

Comparative Study Between Intrathecal Fentanyl and Midazolam as Adjuvant to Local Anesthetics in Spinal Anesthesia in Elective Cesearean Section in Post-Operative Anesthesia and Post-Operative Analgesia

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