A COMPARATIVE STUDY OF POST-OPERATIVE ANALGESIC EFFICACY OF BUPIVACAINE ALONE WITH BUPIVACAINE AND MIDAZOLAM COMBINATION INTRATHECALLY IN PATIENTS UNDERGOING SURGERIES BELOW UMBILICUS.

Dr Nihar Ranjan Tripathy; Prof. Dr Ritesh Roy

Volume : VIII, Issue : I, January - 2019

A COMPARATIVE STUDY OF POST-OPERATIVE ANALGESIC EFFICACY OF BUPIVACAINE ALONE WITH BUPIVACAINE AND MIDAZOLAM COMBINATION INTRATHECALLY IN PATIENTS UNDERGOING SURGERIES BELOW UMBILICUS.

Dr Nihar Ranjan Tripathy, Prof. Dr Ritesh Roy

Abstract :

Introduction : Recent practice of anesthesia has taken excellent care of pain relief during any surgery but the post–operative pain still remains the most horrible and unpleasant experience for patients.It creates a host of negative side effects on the patient as a whole, mainly respiratory and circulatory complications and effects the metabolic, hormonal and autonomic systems of the body. Aim : To compare the post–operative analgesic efficacy of intrathecal Bupivacaine and midazolam combination with Bupivacaine alone in infraumbilical surgeries. Materials & methods : We have undertaken randomized, double blind study of 60 patients undergoing lower abdominal and lower limb surgery under spinal anaesthesia . The study is randomized by closed envelope method. In this 60 envelopes were prepared and were sealed , each containing information about patients either administered 0.5% Bupivacaine (3ml)+0.4 ml Normal saline (group B) or 0.5% Bupivacaine (3ml)+0.4 ml Midazolam (2mg) preservative free (group M). After institutional ethical committee approval, patients undergoing lower abdominal and lower limb surgery under spinal anesthesia of either sex with American Society of Anesthesiologists (ASA) grade I and grade II status posted for elective surgery under regional anesthesia (subarachnoid block) were included in the study .The patients were randomly allocated into 2 groups of 30 each ,namely group B and group M. Informed written consent were taken. Data collected in pretested proforma meeting the objectives of the study. Results : In the present study the duration of post operative analgesic action was prolonged from 120.6 + 5.4 minutes in group B to 220.6 + 12.2 minutes in group M. This was statistically highly significant as p value is <0.0001. In our study, all the patients in group B required supplemental analgesic within first 200 minutes, where as group M patients required it between 230 to 300 minutes postoperatively. Conclusion : In conclusion it can be inferred that midazolam 2mg in combination with bupivacaine 0.5% heavy can be safely administered intrathecally for better postoperative analgesia than bupivacaine alone in lower abdominal, gynecological, urological and lower limb surgeries, without any significant side effects.