Staff Members - Benha University
Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective cesarean section: a randomized controlled double-blind trial
Anaesthesia, Pain & Intensive Care • 2023
Publication Information
Authors
Samar Rafik Amin, Ibrahim Souidan, Elsayed M. Abdelzaam
Keywords
Intrathecal; Nalbuphine; Midazolam; Fentanyl; Postoperative analgesia; Cesarean section.
Journal
Anaesthesia, Pain & Intensive Care
Publisher
Pakistan Society of Anaesthesiologists
Volume
Not Available
Issue
Not Available
Pages
Not Available
publication.type
International
Paper Link
Open Link
Supplementary Materials
Not Available
Abstract
Background: Different adjuvants have been introduced to enhance the quality of local anesthetics and reduce its
adverse events. This study was directed to compare the anesthetic and analgesic properties of intrathecal hyperbaric
bupivacaine when three different adjuvant drugs were added.
Methodology: One hundred full-term parturients aged 18 to 40 years, scheduled for elective cesarean section, were
randomly assigned to 4 groups. Each group received 12.5 mg of 0.5% hyperbaric bupivacaine combined with either
0.5 ml saline (Group-B), 25µg fentanyl (Group-F), 0.8 mg nalbuphine (Group-N) or 2 mg midazolam (Group-M). The
outcomes included the postoperative effective analgesia time, the sensorimotor characteristics, postoperative VAS
score, pethidine consumption, maternal complications, and neonatal Apgar score.
Results: Earlier onset of sensory and motor block was observed in Group F and N than in Group B and M. Duration
of postoperative effective analgesia was longer in Groups F, N and M (252.42 ± 46.11, 227.34 ± 36.54 and 243.71 ±
44.95 hours, respectively) than in Group B (172.11 ± 20.99) (P < 0.001). VAS scores decreased in adjuvant groups
during the first 12 hours postoperative and required pethidine doses were less.
Conclusion: Addition of adjuvant agents to intrathecal bupivacaine improved the quality of subarachnoid block
without increasing side-effects. Intrathecal midazolam provided comparable outcomes as the frequently used
opioids.
adverse events. This study was directed to compare the anesthetic and analgesic properties of intrathecal hyperbaric
bupivacaine when three different adjuvant drugs were added.
Methodology: One hundred full-term parturients aged 18 to 40 years, scheduled for elective cesarean section, were
randomly assigned to 4 groups. Each group received 12.5 mg of 0.5% hyperbaric bupivacaine combined with either
0.5 ml saline (Group-B), 25µg fentanyl (Group-F), 0.8 mg nalbuphine (Group-N) or 2 mg midazolam (Group-M). The
outcomes included the postoperative effective analgesia time, the sensorimotor characteristics, postoperative VAS
score, pethidine consumption, maternal complications, and neonatal Apgar score.
Results: Earlier onset of sensory and motor block was observed in Group F and N than in Group B and M. Duration
of postoperative effective analgesia was longer in Groups F, N and M (252.42 ± 46.11, 227.34 ± 36.54 and 243.71 ±
44.95 hours, respectively) than in Group B (172.11 ± 20.99) (P < 0.001). VAS scores decreased in adjuvant groups
during the first 12 hours postoperative and required pethidine doses were less.
Conclusion: Addition of adjuvant agents to intrathecal bupivacaine improved the quality of subarachnoid block
without increasing side-effects. Intrathecal midazolam provided comparable outcomes as the frequently used
opioids.