Intrathecal midazolam increases the analgesic effects of spinal blockade with bupivacaine in patients undergoing haemorrhoidectomy

Abstract

In the present double-blind study we aimed to evaluate the postoperative analgesic effects of intrathecal midazolam with bupivacaine following haemorrhoidectomy. Forty-five patients were randomly allocated to one of three groups: the control group received 1 ml of 0.5% heavy bupivacaine plus 0.2 ml of 0.9% saline intrathecally, group BM1 received 1 ml of 0.5% bupivacaine plus 0.2 ml of 0.5% preservative-free midazolam and group BM2 received 1 ml of 0.5% bupivacaine plus 0.4 ml of 0.5% midazolam. Time to first analgesia was significantly greater in the midazolam groups than in the placebo and significantly less in the BM1 group than in the BM2 group.

Brachial plexus block with midazolam and bupivacaine improves analgesia

“…This could be due to a local anesthetic property of midazolam and its synergistic action with that of local anesthetics. [10][11][12] The onset of motor block was found to be faster than the onset of sensory block in both groups. Winnie et al 16 observed this also, and attributed this to the Group B = were administered bupivacaine; Group BM = were administered bupivacaine and midazolam.…”

“…[10][11][12] Gulec et al 17 found that a bupivacaine and midazolam combination prolonged postoperative analgesia compared to a bupivacaine-morphine combination when administered caudally. Nishiyama et al 11 added midazolam to a continuous epidural infusion of bupivacaine and observed improved analgesia.…”

“…Midazolam produces this effect by its action on gamma aminobutyric acid-A (GABA-A) receptors. [10][11][12] GABA receptors have also been found in peripheral nerves. [13][14][15] However, the effect of adding midazolam to a local anesthetic solution in peripheral nerve blocks has not been studied.…”

Effect of Different Doses of Dexmedetomidine as Adjuvant in Bupivacaine -Induced Subarachnoid Block for Traumatized Lower Limb Orthopaedic Surgery: A Prospective, Double-Blinded and Randomized Controlled Study

“…Local anaesthetics alone for subarachnoid block provide good operative conditions but have shorter duration of postoperative analgesia. So various drugs like opioids [7], epinephrine [8], neostigmine [9], magnesium [10], midazolam [11], ketamine [12], and clonidine [13] have been used as adjuvant to intrathecal local anaesthetics to achieve quick, dense and prolonged block, but the results were associated with side effects.…”

“…Diverse classes of drugs such as opioids [7], epinephrine [8], neostigmine [9], magnesium [10], midazolam [11], ketamine [12], and clonidine [13] have been added to intrathecal local anaesthetics in an attempt to prolong analgesia and reduce the incidence of adverse events.…”