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The analgesic and sedative effects of intrathecal midazolam in perianal surgery

Published online by Cambridge University Press:  23 December 2004

A. Yegin ,
S. Sanli ,
L. Dosemeci ,
N. Kayacan ,
M. Akbas  and
B. Karsli
A. Yegin
Affiliation:
Akdeniz University Medical Faculty, Department of Anaesthesiology, Antalya, Turkey
S. Sanli
Affiliation:
Akdeniz University Medical Faculty, Department of Anaesthesiology, Antalya, Turkey
L. Dosemeci
Affiliation:
Akdeniz University Medical Faculty, Department of Anaesthesiology, Antalya, Turkey
N. Kayacan
Affiliation:
Akdeniz University Medical Faculty, Department of Anaesthesiology, Antalya, Turkey
M. Akbas
Affiliation:
Akdeniz University Medical Faculty, Department of Anaesthesiology, Antalya, Turkey
B. Karsli
Affiliation:
Akdeniz University Medical Faculty, Department of Anaesthesiology, Antalya, Turkey
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Abstract

Summary

Background and objective: Our purpose was to evaluate the analgesic and sedative effects of intrathecal midazolam when added to spinal bupivacaine in patients undergoing perianal surgery under spinal anaesthesia.

Methods: Forty-four patients were randomly allocated into two equal groups: Group I (B) received hyperbaric bupivacaine 0.5% 2 mL + saline 0.9% 1 mL in a total volume of 3 mL intrathecally; Group II (BM) received hyperbaric bupivacaine 0.5% 2 mL + 1 mL of 2 mg preservative-free midazolam in a total volume of 3 mL intrathecally. In both groups, the onset and recovery times of sensory block, the degree and recovery times of motor block as well as the sedation and visual analogue pain scores were recorded, and statistically compared.

Results: In Group BM, the postoperative visual analogue pain scores were significantly lower at the first 4 h (P < 0.05), the average time until the first dose of additional analgesic requirement was significantly longer (P < 0.05), and sedation scales were significantly higher (P < 0.05), compared to Group B. There were no statistically significant differences in the onset and the full recovery times of sensory and motor blocks in the two groups.

Conclusion: The use of intrathecal midazolam combined with intrathecal bupivacaine produces a more effective and longer analgesia with a mild sedative effect in perianal surgery.

Keywords

ANAESTHESIA, spinalMIDAZOLAM, drug effectsPAIN, postoperative
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 8 , August 2004 , pp. 658 - 662
Copyright
2004 European Society of Anaesthesiology

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References

Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth 1995; 42: 891–903.Google Scholar
Batra YK, Jain K, Chari P, Dhillon MS, Shaheen B, Reddy GM. Addition of intrathecal midazolam to bupivacaine produces better postoperative analgesia without prolonging recovery. Int J Clin Pharmacol Ther 1999; 37: 519–523.Google Scholar
Nishiyama T, Matsukawa T, Hanaoka K. Effects of adding midazolam on the postoperative epidural analgesia with two different doses of bupivacaine. J Clin Anesth 2002; 14: 92–97.Google Scholar
Sen A, Rudra A, Sarkar SK, Biswas B. Intrathecal midazolam for postoperative pain relief in caesarean section delivery. J Ind Med Assoc 2001; 99: 683–684.Google Scholar
Kim MH, Lee YM. Intrathecal midazolam increases the analgesic effects of spinal blockade with bupivacaine in patients undergoing haemorrhoidectomy. Br J Anaesth 2001; 86: 77–79.Google Scholar
Raj PP. Practical Management of Pain, 3rd edn. Missouri: Mosby Inc., 2000: 689–709.
Johnston GAR. GABA-A receptor pharmacology. Pharmacol Ther 1996; 69: 173–198.Google Scholar
Valentine JM, Lyons G, Bellamy MC. The effect of intrathecal midazolam on postoperative pain. Eur J Anaesthesiol 1996; 13: 589–593.Google Scholar
Serrao JM, Marks RL, Morley SJ, Goodchild CS. Intrathecal midazolam for the treatment of chronic mechanical low back pain: a controlled comparison with epidural steroid in a pilot study. Pain 1992; 48: 5–12.Google Scholar
Borg PA, Krijnen HJ. Long term intrathecal administration of midazolam and clonidine. Clin J Pain 1996; 12: 63–68.Google Scholar
Kohno T, Kumamoto E, Baba H. Actions of midazolam on GABAergic transmission in substantia gelatinosa neurones of adult rat spinal cord slices. Anesthesiology 2000; 92: 507–515.Google Scholar
Goodchild CS, Serrao JM. Intrathecal midazolam in the rat: evidence for spinally-mediated analgesia. Br J Anaesth 1987; 59: 1563–1570.Google Scholar
Nishiyama T. Acute phase histopatological study of spinally administered midazolam in cats. Anesth Analg 1999; 89: 717–720.Google Scholar
Serrao JM, MacKenzie JM, Goodchild CS, Gent JP. Intrathecal midazolam in the rat: an investigation of possible neurotoxic effects. Eur J Anaesthesiol 1990; 7: 115–122.Google Scholar
Erdine S, Yucel A, Ozyalcin S, et al. Neurotoxicity of midazolam in the rabbit. Pain 1999; 80: 419–423.Google Scholar
Svensson BA, Welin M, Gordh T Jr, Westman J. Chronic subarachnoid midazolam (Dormicum) in the rat. Morphologic evidence of spinal cord neurotoxicity. Reg Anesth 1995; 20: 426–434.Google Scholar