Comparison of Intrathecal Bupivacaine and Bupivacaine plus Midazolam in Spinal Analgesia

KANHAIYA LAL KISHNANI; ANKITA GUPTA; AKANSHA BANSAL

Volume : VIII, Issue : VI, June - 2019

Comparison of Intrathecal Bupivacaine and Bupivacaine plus Midazolam in Spinal Analgesia

Kanhaiya Lal Kishnani, Ankita Gupta, Akansha Bansal

Abstract :

Introduction: The concept of postoperative pain relief has improved dramatically over recent years. Intrathecal local analgesics with different adjuvants are being tried in Spinal analgesia for pain relief and prolongation of time of analgesia. Intrathecal Midazolam is known to produce antinociception and potentiating the effect of local anaesthetics. The aim of this study was to compare intrathecal Bupivacaine and intrathecal Bupivacaine with Midazolam on the onset and duration of sensory block, motor block and effect on pain relief. Material and Methods: Total 100 patients of ASA Grade I and II between the age group of 25 to 50 years of age undergoing surgery below umbilicus under spinal analgesia were studied. They were divided into 2 groups of 50 patients each. Bupivacaine Group received intrathecal 3.0 ml of Bupivacaine heavy 0.5% and 0.4 ml of Normal saline, Bupivacaine– Midazolam Group received intrathecal 3.0 ml of Bupivacaine heavy 0.5% and 0.4 ml of (5.0 mg/ml) preservative free Midazolam in spinal block. Lumbar puncture was performed at L 3–4 level, with a 25 gauge Quincke spinal needle via midline approach in sitting position. The drugs were injected through a spinal needle over a period of 15 seconds. Time of regression of sensory block and recovery from motor blockade was noted. Time of first rescue analgesia was noted. The patients were also observed for any side effect. Results: We observed that onset of sensory block was faster in Bupivacaine – Midazolam group than in Bupivacaine Normal saline group. The duration of post operative analgesia was more in Bupivacaine–Midazolam group as request for first rescue analgesia and further requirement of analgesia was also less in this group. The variation in the vital parameters was comparable in both the groups. Symptoms of nausea vomiting were minimal and there was no respiratory depression in both groups. Conclusion: We arrived at conclusion that addition of preservative free Midazolam to Intrathecal Bupivacaine produced optimal operating conditions and produced prolonged post operative analgesia without significant side effects.