The analgesic and sedative effects of intrathecal midazolam in perianal surgery

Yeğin, Arif; Sanlı, Suat; Döşemeci, L; Kayacan, Nurten; Akbaş, Mert; Karslı, Bilge

doi:10.1097/00003643-200408000-00012

Cited by 33 publications

(29 citation statements)

References 11 publications

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“…However, it is in contrast to Yegin et al [30] who reported a prolonged analgesia with mild sedation in perianal cases on using a higher dose midazolam (5 mg) and that is maybe the cause of the sedation in their study.…”

Section: Discussioncontrasting

confidence: 76%

Comparing the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam or Magnesium Sulphate Combination in Patients Undergoing Elective Infraumbilical Surgery

Attia

Elhussien

Zaki

2016

Journal of Anesthesiology

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Background.Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia.Aim of the Work.The aim of this study was to decrease bupivacaine dose used in spinal anesthesia in patients undergoing orthopedic lower limb surgery and reduce its possible side effects.Patient and Methods.Sixty adult patients of both sexes, divided into three.Group Creceived 2.5 mL bupivacaine and 0.5 mL saline 0.9%.Group Areceived 2.5 mL bupivacaine and 0.5 mL midazolam.Group Breceived 2.5 mL bupivacaine and 0.5 mL magnesium sulphate.Results.As regards onset of both motor and sensory blockade, there are a significant decrease in group A and a significant increase in group B as compared to group C, with a significant decrease in duration of motor blockade and significant increase in duration of sensory blockade in both group A and group B, respectively, as compared to group C, with a significant decrease in the duration of sensory blockade in group B as compared to group C.Conclusions.These results suggested that intrathecal midazolam as an adjuvant for bupivacaine increases the duration of both sensory and motor blockade more than that of magnesium sulphate.

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Section: Discussioncontrasting

confidence: 76%

Comparing the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam or Magnesium Sulphate Combination in Patients Undergoing Elective Infraumbilical Surgery

Attia

Elhussien

Zaki

2016

Journal of Anesthesiology

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“…13,14 Yegin A et al, have found in their study that addition of 2mg of midazolam to hyperbaric bupivacaine in spinal anesthesia does not delay onset of sensory compared to hyperbaric bupivacaine alone in patients undergoing perianal surgery. 15 From the above study it can be seen that there is no quickening in the onset of sensory blockade up on addition of intrathecal midazolam to bupivacaine.…”

Section: Onset Of Sensory Blockadementioning

confidence: 80%

“…18,20,21 Yegin A et al, and in 2004 studied the effect of intrathecal midazolam and hyperbaric bupivacaine in comparison to hyperbaric bupivacaine alone and found significantly longer time until the first dose of additional analgesic requirement in midazolam group. 15 Bharti N et al, found prolonged duration of postoperative pain relief in midazolam group. 19 Thus, authors can observe that intrathecal midazolam along with bupivacaine prolongs the duration of analgesia thus prolonging the first request of supplemental analgesics in the post-operative period.…”

Section: Duration Of Analgesiamentioning

confidence: 96%

“…The number of patients having sedation in midazolam group was comparable with Yegin A et al, (five patients had sedation)(22.7%). 15 According to Yun MJ et al, The sedative effect of intrathecal midazolam seemed to be slower than intravenous midazolam. 17 The mechanism of sedative effect of intrathecal midazolam was not defined but the cephalad spread in the cerebro-spinal fluid or systemic absorption may contribute.…”

Section: Sedationmentioning

confidence: 99%

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Effect of addition of intrathecal midazolam to 0.5% hyperbaric bupivacaine to prolong the post-operative analgesia in lower abdominal surgeries

Hasan

2019

Int J Adv Med

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Background: Bupivacaine when used alone produces analgesia for 2.5 to 3 hours, making it unsuitable in cases where the duration of surgery is longer and in cases which require further analgesia during post-operative period. Present study is intended to evaluate the effect of addition of intrathecal midazolam to bupivacaine to prolong the post-operative analgesia.Methods: Present clinical study was conducted in Kamineni Institute of Medical Sciences, Narketpally, Nalgonda District, Andhra Pradesh, India. After obtaining approval from institutional ethical committee, present clinical study was undertaken to evaluate the effects of addition of intrathecal midazolam to bupivacaine 0.5% (heavy). The study was conducted on 60 patients undergoing lower abdominal surgeries.Results: Mean onset of analgesia was 190.5 with SD 21.3 in group-C whereas in group-M, mean onset of analgesia was 185.3 with SD 26.81. Mean difference between the groups not showing statistical significance. In the present study the Maximum height of sensory blockade in control and midazolam group was T7 (T6-T8) compared to T7 (T6-T8) midazolam group. Mean duration of sensory blockade was 130.4 with SD 36.36 in group-C whereas in group-M, mean duration of sensory blockade was 191.9 with SD 36.4. Mean difference between the groups showing statistical significance. Mean duration of motor blockade was 176.3 with SD 23.7 in group-C whereas in group-M, mean duration of motor blockade was 208.1 with SD 18.21. Mean difference between the groups showing statistical significance.Conclusions: Midazolam is a useful adjuvant to bupivacaine in subarachnoid block. Intrathecal midazolam combined with intrathecal bupivacaine produces a longer and more effective anaesthesia and analgesia. It also prolongs post-operative analgesia without increasing adverse effects.

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“…In 2004, Yegin et al [42] conducted study on analgesic and sedative effects of intrathecal 2 mg preservative free midazolam in perianal surgery under spinal anaesthesia. They found that the postoperative VAS scores were significantly lower at the first 4 hours in patients who received bupivacaine-midazolam combination than bupivacaine alone and the average time until the first dose of rescue analgesic requirement was significantly longer.…”

Section: Human Clinical Evidencementioning

confidence: 99%

Midazolam in Subarachnoid Block: Current Evidence

Chattopadhyay

Maitra

Sen

2013

ISRN Anesthesiology

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Midazolam, despite of being the commonest benzodiazepine used in anaesthesia and perioperative care, is a relatively newer addition to the list of adjuvant used in subarachnoid block. Midazolam causes spinally mediated analgesia and the segmental analgesia produced by intrathecal midazolam is mediated by the benzodiazepine-GABA receptor complex. Initial animal studies questioned the safety of intrathecal midazolam in terms of possible neurotoxicity. However subsequent clinical studies also failed to show any neurotoxicity of high dose midazolam even on long-term use. Addition of intrathecal midazolam to bupivacaine significantly improves the duration and quality of spinal anaesthesia and provides prolonged perioperative analgesia without any significant side effects. Clinical studies also reported its safety and efficacy in pregnant women, but some studies also reported mild sedation with intrathecal midazolam. It is also reported to decrease the incidence of PONV. Intrathecal midazolam does not have any clinically significant effect on perioperative hemodynamics.

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The analgesic and sedative effects of intrathecal midazolam in perianal surgery

Cited by 33 publications

References 11 publications

Comparing the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam or Magnesium Sulphate Combination in Patients Undergoing Elective Infraumbilical Surgery

Comparing the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam or Magnesium Sulphate Combination in Patients Undergoing Elective Infraumbilical Surgery

Effect of addition of intrathecal midazolam to 0.5% hyperbaric bupivacaine to prolong the post-operative analgesia in lower abdominal surgeries

Midazolam in Subarachnoid Block: Current Evidence

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