Comparative study between epidural verapamil and midazolam for postoperative analgesia in lower abdominal surgeries

Sixty patients ASA physical status I and II were studied. They were scheduled for elective short or moderate lower abdominal surgical procedures. They were randomly divided into three groups 20 patients each: gpI received 10ml bupivacaine 0.25% diluted in normal saline, gp II, received 0.05mg/kg midazolam and bupivacaine 0.25% in a total volume of 10ml. gp III, received 5mg verapamil, and bupivacaine 0.25% in a total volume of 10ml. All patients received standardized general anesthesia and the study drug was injected at the end of surgery. Routine monitorings were applied to all patients and lasted throughout the study period for the 1[st] 6 hours postoperative. Systolic, Diastolic blood pressure, HR were measured, the intensity of postoperative pain was assessed by VAS and the depth of sedation by the Observer's Assessment of Alertness/Sedation Score [OAA/S]. No significant changes in the hemodynamics occurred among groups, VAS showed significant decrease in gp II [bupivacaine. midazolam] 15mm after injection and lasted for shorter duration than the other 2 groups. OAA/S only changed in gp II patients. We concluded that epidural midazolam gives good postoperative analgesia with rapid onset but the accompanied sedation may limit early ambulation, on the other hand verapamil contributes to a better more prolonged postoperative analgesia devoid of sedation

Nalbuphine, propofol and ondansetron for ttreatment of intrathecal morphine-induced pruritus

Background: intrathecally and epidurally administered morphine is frequently associated with pruritus. The aim of this study is to compare the efficacy of Nalbuphine. Propofol, and Ondansetron for treating intrathecal morphine induced pruritus after lower abdominal surgeries

Methods: In this prospective, randomized study 124 patients who developed moderate to severe pruritus after administration of intrathecal morphine were randomly allocated into three groups. One group received 3mg i.v nalbuphine, the second group received 20 mg i.v propolol and the third group received 8 mg i.v ondansetron. The improvement of pruritus and other adverse effects were determined at 15 mm after study drug administration. A decrease in pruritus score to 1-2 was considered a treatment success. Changes in the level of pain, sedation, hemodynamic values, and other side effects were checked regularly. Patients were rechecked 24 hours later for the presence or absence of pruritus

Results: There was no significant difference between the three groups as regards the demographic characteristics, the rout of morphine administration, and severity of pruritus at the beginning of the study. Nalbuphine group showed a success rate of 87.8% [pruritus score decreased to 1-2]. Propofol group showed success rate of 63.41% and 64.28% success in Ondansetron group. Among the successfully treated patients 7.31% in nalbuphine group, and 9.75% in propofol group reported recurrence of pruritus within 4 hours of study drug administration, while 11.9% in ondansetron group reported recurrence of pruritus within 5-7 hours of study drug administration. Among the successfully treated patients, none complained of residual pruritus 24 h later. Pain score insignificantly increased in both nalbuphine and propofol groups hut it did not change in ondansetron group. Sedation level significantly increased in both nalbuphinc and propolol groups but it did not change in ondansetron group. 1-lemodynarnic values remained stable, hemoglobin oxygen saturation did not change and no other side effects were observed in the three groups throughout the study

Conclusion: This study showed that Nalbuphine was superior to Propofol and Ondansetron for treatment of intrathecal morphine-induced pruritus