Reduction in labor pain by intrathecal midazolam as an adjunct to sufentanil / 대한마취과학회지

BACKGROUND: Anesthesia today has strived to decrease labor pain in a tolerable and controllable fashion. Intrathecal midazolam has been introduced as an adjunct to analgesics. The study was planned to assess the efficacy, safety and duration of analgesia produced by intrathecal midazolam adjunct to sufentanil in decreasing labor pain. METHODS: In a randomized clinical trial 80 parturient included in the study. The two groups were matched for age, cervical dilation, gravid, gestational age, and other demographic characteristics. Combination of sufentanil and midazolam administered intrathecally to experimental group and compared to sufentanil group. Time to reach maximum block, and pain score was measured and recorded. RESULTS: Groups were matched for age and weight and other demographic characteristic. No significant adverse effect was seen in both groups including decrease in Apgar score. Duration of analgesia was 92.0 +/- 12.7 in sufentanil group and 185.2 +/- 15.2 minutes in midazolam and sufentanil group which was significantly different (P = 0.002). Numeric rating scale score was significantly lower in midazolam group compare to sufentanil group at 120 min (P = 0.01), 150 min (P = 0.0014), and 180 min (P = 0.001). CONCLUSIONS: Intrathecal midazolam as an adjunct to opioid could significantly enhance analgesia in labor pain with no significant adverse effect. Intrathecal injection of midazolam is an appropriate alternative to parenteral or epidural analgesia in small hospital settings.

The effect of adjuvant midazolam compared with fentanyl on the duration of spinal anesthesia with 0.5% bupivacaine in opium abusers / 대한마취과학회지

BACKGROUND: There are a number of adjuvants to be used for local anesthetics in spinal block. The aim of this study was to demonstrate the possible effect of intrathecal midazolam compared with bupivacaine as adjuvants in spinal anesthesia with bupivacaine in chronic opium abuses. METHODS: In a double blind, randomized clinical trial, 90 opium abuser patients undergoing lower limb orthopedic surgery were selected and randomly assigned into 3 groups (30 cases each). The patients received 15 mg plain bupivacaine, or 15 mg bupivacaine plus 25 mcg fentanyl or 15 mg bupivacaine plus 1 mg midazolam, intrathecally. RESULTS: The duration of anesthesia was much longer in the bupivacaine-midazolam group than the bupivacaine-fentanyl group; both were longer than the plain bupivacaine group (P < 0.05). CONCLUSIONS: Subarachnoid injection of adjuvant midazolam or fentanyl with plain 0.5% bupivacaine in opium abusers in lower limb orthopedic surgery increases the duration of sensory block. Therefore midazolam is more effective than fentanyl in such cases.

Comparison of the role of intrapleural bupivacaine injection with intravenous morphine in the management of post-operative pain after open cholecystectomy

Post-operative pain after open cholecystectomy can result in increased oxygen consumption, increased risk of myocardial ischemia, atelectasis, pneumonia, decreased vital capacity, and increased morbidity and mortality. In this study we compared the analgesic effects of intrapleural bupivacaine with intravenous morphine post-operatively. Sixty patients who were candidates for elective open cholecystectomy were randomly divided into two groups based on randomized numbers for a double-blinded randomized clinical trial. Anesthesia technique was precisely the same for all patients. At the end of surgery, 20 cc of 0.5% bupivacaine and epinephrine with a concentration of 1/200, 000 was injected intrapleurally for group B patients; whereas, 0.1 mg/kg intravenous morphine and 20cc normal saline was injected intrapleurally for group M cases. In order to obtain a visual analog scale[VAS] <3, morphine consumption up to 12 hours post-op was 10.5 +/- 3.2 mg in group M which was much more than that of group B, in which this amount was 4.3 +/- 1.5 mg. This difference was statistically significant [P<0.05]. The mean frequency of morphine injection was 3.7 +/- 1.3 times in group M and 1.2 +/- 0.7 times in group B and the difference in this regard was statistically significant. The patients' first demand for morphine was 1.8 +/- 0.6 and 4.2 +/- 0.3 hours postoperatively for groups M and B respectively. The difference in this regard was statistically significant [P<0.05]. In this study we realized that a single shot of intrapleural bupivacaine can provide an almost favorable analgesia for the management of post-operative pain due to open cholecystectomy compared to other current analgesic methods. It may reduce the related complications as well. We observed no complication due to the single shot of intrapleural bupivacaine