A Comparative Study Of Intrathecal Bupivacaine And Bupivacaine With Midazolam In Lower Abdominal And Lower Limb Surgeries

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.