Midazolam in Subarachnoid Block: Current Evidence

Chattopadhyay, Anirban; Maitra, Souvik; Sen, Suvadeep

doi:10.1155/2013/202835

Cited by 6 publications

(7 citation statements)

References 40 publications

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“…Therefore, it can be helpful to develop a technique that allows sparing of the neuraxial opioid, replacing it with other adjuvants. This strategy was based on limited but encouraging evidences that midazolam and ketamine significantly improve the duration and quality of spinal anesthesia, reduce the onset time of sensory and motor block, provide a mild intraoperative sedative effect, ensure prolonged perioperative analgesia due to delayed recovery time of sensory block, and decrease the incidence of postoperative nausea and vomiting (PONV) without negative effects on perioperative hemodynamics, significant adverse effects, and neurotoxicity [ [29] , [30] , [31] ].…”

Section: Discussionmentioning

confidence: 99%

“…A regimen of “opioid-free” postoperative continuous analgesia, such as that adopted in our study, which might provide similar results in pain management allowing at the same time to avoid the serious adverse effects of intrathecal opioids, can be a precious resource in older surgical patients. The potent analgesic effect of intrathecal midazolam may be induced by the release of an endogenous opioid acting at spinal δ receptors combined with its predominant agonistic action on the GABA-A receptors located in lamina II of dorsal horns of human spinal cord [ 29 ]. Minimal systemic absorption and the absence of systemic and neurological adverse effects are the other remarkable advantages of this benzodiazepine when used intrathecally compared to opioids [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…The potent analgesic effect of intrathecal midazolam may be induced by the release of an endogenous opioid acting at spinal δ receptors combined with its predominant agonistic action on the GABA-A receptors located in lamina II of dorsal horns of human spinal cord [ 29 ]. Minimal systemic absorption and the absence of systemic and neurological adverse effects are the other remarkable advantages of this benzodiazepine when used intrathecally compared to opioids [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

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Continuous thoracic spinal anesthesia with local anesthetic plus midazolam and ketamine is superior to local anesthetic plus fentanyl in major abdominal surgery

Vincenzi

Starnari

Faloia

et al. 2020

Surgery Open Science

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Background Limited studies have applied thoracic continuous spinal anesthesia in abdominal surgery, relying exclusively on opioids. This retrospective study analyzes 2 different schemes of thoracic continuous spinal anesthesia and postoperative analgesia in elderly patients undergoing major abdominal surgery. Methods A total of 98 patients aged ≥ 75 years were divided into 2 groups. The control group (60 patients) received bupivacaine plus fentanyl, whereas the study group (38 patients) received bupivacaine plus ketamine and midazolam. Both received analogous postoperative continuous intrathecal analgesia. Several perioperative variables were evaluated. Results Spinal anesthesia was performed without complications in all patients. Doses of noradrenaline administered, incidence of respiratory depression, need for intraoperative sedation, and time to first flatus were significantly reduced in the bupivacaine plus ketamine and midazolam group. Conclusion In a population of frail, elderly patients, thoracic continuous spinal anesthesia with local anesthetic plus midazolam and ketamine was superior to local anesthetic plus fentanyl. In the group receiving local anesthetic plus midazolam and ketamine, the incidence of respiratory depression was reduced, and doses of norepinephrine and intraoperative sedating medications were lower. Intraoperative anesthesia and postoperative analgesia were similar in both groups.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Continuous thoracic spinal anesthesia with local anesthetic plus midazolam and ketamine is superior to local anesthetic plus fentanyl in major abdominal surgery

Vincenzi

Starnari

Faloia

et al. 2020

Surgery Open Science

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“…Midazolam as antiemetic acts by reducing synthesis, release and postsynaptic effect of dopamine at chemoreceptor trigger zone. 14,15 There have been earlier studies for evaluating the efficacy of intrathecal midazolam in prevention of PONV. Suwalka et al 16 evaluated the postoperative analgesic effect of intrathecal midazolam-lignocaine mixture in patients undergoing caesarean section and found that incidence of nausea and vomiting was less in midazolam group when compared to lignocaine group(1:8).…”

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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“…It has been extensively used both in critical care medicine and operating room for its sedative, anxiolytic and amnestic effects; but probable use of intrathecal midazolam as an adjuvant to bupivacaine is a comparatively newer concept in anaesthesia practice. 3 With the discovery of benzodiazepine receptors in spinal cord in 1977, intrathecal use of midazolam for potentiating the effect of anaesthetics used in subarachnoid block was started. 4 It acts through BZD-GABA receptor complex at spinal cord level, specifically GABA-A receptors which are in highest concentration in lamina-II or the dorsal horn ganglia leading to segmental analgesia without any neurotoxic effects.…”

Section: Resultsmentioning

confidence: 99%

A Study of Intrathecal Bupivacaine and Bupivacaine With Midazolam in Lower Abdominal Surgeries

Deka¹,

Abraham²,

Mallikarjun³

et al. 2018

jemds

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BACKGROUND Several adjuvants have been tried along with local anaesthetic in spinal anaesthesia for prolonging the duration of analgesia . Intrathecal midazolam produces anti-nociception and potentiates the effect of local anaesthetics. The aim of this study is to study the comparison between intrathecal bupivacaine and bupivacaine with midazolam with spinal anaesthesia. MATERIALS AND METHODSThis is a comparative, randomised, double-blinded study of 90 patients within the age group of 18 -60 years with ASA status I or II, undergoing various lower abdominal surgical procedures. They were randomly allocated to one of the two groups, each containing 45 patients as follows: The B group receiving 2 mL of 0.5% hyperbaric bupivacaine (10 mg) and 1 mL of 0.9% saline intrathecally; the BM group receiving 2 mL of 0.5% hyperbaric bupivacaine (10 mg) with 1 mL (1 mg) of preservative-free midazolam. The onset, duration of sensory/ motor block, the time to achieve maximum sensory block and the level of block, time for first rescue analgesia, sedation score, quality of anaesthesia and side effects were noted. RESULTSThere was no significant difference in the demographic distribution of the patients. There was no statistically significant difference in the onset of the sensory block (p-value > 0.05) and time to achieve maximum level of sensory block in both groups (p-value > 0.05). Mean duration of sensory block or effective analgesia in group BM was 330.88 ± 16.36 minutes, while that in group B was 273.68 ± 15.69 minutes, which was statistically significant (p-value < 0.05). There was no statistically significant difference between both the groups with respect to motor block and quality of anaesthesia. The sedation score was comparable in both groups. The side effect profiles in both groups were also comparable. CONCLUSIONThe addition of 1 mg preservative-free midazolam to 0.5% hyperbaric bupivacaine prolongs the duration of effective analgesia as compared to bupivacaine alone and delays the need for postoperative rescue analgesics without affecting the onset of block and without increasing the risk of side effects. Spinal anaesthesia with bupivacaine is routinely administered for lower abdominal surgeries with adequate motor blockage, additionally providing effective pain relief in the initial post-operative period due to its long duration of action. 1 However, the Cardiovascular Collapse/ Central Nervous System (CC/CNS) ratio of bupivacaine is narrow (2.7) with a higher propensity of irreversible cardiovascular collapse. 1 'Financial or Other Competing Interest': None. Submission 22-11-2017, Peer Review 16-12-2017, Acceptance 22-12-2017, Published 08-01-2018. Corresponding Author: Dr. Partha Pratim Deka, Meridiyen Apartments, Apt. No. 409, Deralakatte, Yenepoya Medical College, Mangalore-575018, Karnataka, India. E-mail: dr.parthadeka@live.in DOI: 10.14260/jemds/2018 Therefore, in order to minimise the dose of bupivacaine and to reduce its side effects the use of an adjuvant that would prolong its duration...

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Midazolam in Subarachnoid Block: Current Evidence

Cited by 6 publications

References 40 publications

Continuous thoracic spinal anesthesia with local anesthetic plus midazolam and ketamine is superior to local anesthetic plus fentanyl in major abdominal surgery

Continuous thoracic spinal anesthesia with local anesthetic plus midazolam and ketamine is superior to local anesthetic plus fentanyl in major abdominal surgery

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

A Study of Intrathecal Bupivacaine and Bupivacaine With Midazolam in Lower Abdominal Surgeries

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