A Study to Compare the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam Combination in Patients Undergoing Elective Infraumbilical Surgery
Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia. Several adjuvants have been tried along with local anesthetic for prolonging the duration of analgesia. In this study, we have observed the effect of midazolam as an adjuvant in patients undergoing infraumbilical surgery. In this prospective, randomized, double blinded, and parallel group and open label study of 90 adult patients aged 18–60 years, of American Society of Anaesthesiologists (ASA) status I and II, scheduled for elective infraumbilical surgery, were randomly allocated in two groups. Each patient in group “B” received hyperbaric bupivacaine 12.5？mg along with 0.4？mL of normal saline in the subarachnoid block, and patients of group “BM” received 12.5？mg hyperbaric bupivacaine along with preservative free midazolam 0.4？mL (2？mg). We found that use of midazolam as adjuvant with the local anesthetic in spinal anaesthesia significantly increases the duration of analgesia (median 320？min versus 220？min) and motor block (median 255？min versus 195？min) but decreases the incidence of postoperative nausea-vomiting (PONV). 1. Introduction Spinal subarachnoid block is one of the most versatile regional anesthesia techniques available today. Regional anesthesia offers several advantages over general anesthesia—blunts stress response to surgery, decreases intraoperative blood loss, lowers the incidence of postoperative thromboembolic events, and provides analgesia in early postoperative period. Subarachnoid block provides adequate anesthesia for patients undergoing infraumbilical surgery. Among the local anesthetics, 0.5% hyperbaric bupivacaine is the most commonly used drug for spinal anesthesia [1]. The most important disadvantage of single injection SAB is the limited duration. Adjuvants have long been used along with local anesthetics to prolong the duration of anesthesia and analgesia. Prolongation of pain relief by various adjuvants like opioids (like morphine [2], fentanyl [3]), ketamine [4], clonidine [5], and neostigmine [6] were investigated by various investigators. However, each drug has its limitations and side effects, and the need for an alternative methods and drugs always exist. Discovery of benzodiazepine receptors in spinal cord in 1977 [7] triggered the use of intrathecal midazolam for prolongation of spinal anesthesia. In vitro autoradiography has shown that there is a high density of benzodiazepine (GABA-A) receptors in Lamina II of the dorsal horn in the human spinal cord,
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