Abstract:
Background & Objectives :
Subarachnoid blockade is the common form of centrineuraxial blockade
performed for lower abdominal and lower limb surgeries. In order to maximize
quality and duration of anaesthesia and post operative analgesia, a number of
adjuvants have been added to spinal local anaesthetics. Intrathecal midazolam
abolishes pain of somatic origin, produces selective sensory block, and depresses
somatosympathetic reflexes without any neurotoxicity and other complications. It
potentiates the blocking actions of local anaesthetics. The present study was
conducted to compare the differences of action and complications of intrathecal
hyperbaric Bupivacaine 0.5% (group B) and intrathecal hyperbaric Bupivacaine 0.5%
and Midazolam 1mg in lower abdominal and lower limb surgeries.
Materials and Methods :
100 patients belonging to ASA grade – I and grade-II of both the sexes (each
group 50 patients n=50) were randomly selected for the study. The time of onset of
sensory and motor block, hemodynamic status, time for two dermatomal segments
regression of sensory level and regression of sensory level to L2 dermatome, time of
first request of analgesics, visual analogue score and adverse effects were compared
in both the groups.
Results :
The time of onset of sensory and motor block was significantly longer in
group-BM than group-B (P<0.001) Hemodynamic changes did not differ in patient of
either group (P>0.05). The time for two dermatomal segments regression of sensory
level (group –B 87.50±4.4 minutes and group –II 122.00± 3.6 minutes) and regression
xii
of sensory level to L2 dermatome (Group-B 87.2±3.4 minutes and group-BM
122.6±3.6 minutes) were statistically longer in group BM (P<0.001). The time of first
request of analgesics by the patient in group-B was 139.6±8.7 minutes and in group
BM was 263.8±35.8 minutes which was statistically significant (P<0.001). The VAS
scores were significantly less in group-BM at 3 hours (p<0.001), 6 hours (P<0.001)
and 12 hours (P<0.001) compared to group-B. The side effects were minimal in both
the groups.
Conclusion :
From the present study it can be concluded that addition of intrathecal
midazolam with bupivacaine significantly improves the quality of anaesthesia,
duration of analgesia without prolonging the recovery from the anaesthesia.
