A placebo-controlled trial of midazolam as an adjunct to morphine patient-controlled analgesia after spinal surgery

Perioperative Care of Patients Undergoing Major Complex Spinal Instrumentation Surgery: Clinical Practice Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

“…Bolus and maximal hourly doses may have to be individualized; thus, a universal dosing regimen may not be applicable. [129][130][131] Clinicians should account for the effects of demand-only patient-controlled analgesia, basal rate patient-controlled analgesia, and transdermal analgesia regarding effects on respiratory depression and the need for capnography and pulse oximetry. The side effects of transdermal analgesia include nausea/vomiting and erythema.…”

Does intravenous midazolam induce hyperalgesia?

“…16 Shortly after, the same authors conducted a randomized controlled trial in women submitted to hysterectomy and did not find any significant effect of midazolam premedication on postoperative pain. 17 Three other human studies found the same antinociceptive effect, [23][24][25] with patients under midazolam needing less and later postoperative rescue analgesics. However, pain was measured in the early postoperative period when patients were still under the sedative effect of midazolam.…”

Comparison of morphine–midazolam versus morphine injection for pain relief in patients with limb fractures - a clinical trial

“…The researchers found that although there was no significant difference in pain scores, the treatment group used significantly less morphine than the control group and felt better. [19] On the other hand, several studies have questioned analgesic enhancement by midazolam. Wille-Ledon and colleagues have demonstrated a similar pain relief profile for Morphine and Morphine-Midazolam combination in the pediatric population with limb fractures.…”

“…The use of morphine-midazolam (M/M) combination in painful conditions is based on the well-known relationship between anxiety and pain. [16,17] Despite animal studies suggesting the possibility of increased nociception with the use of midazolam, [18] the bulk of clinical studies have either reported better pain control, [16,19,20] or no significant effect. [21][22][23] This study aimed to compare M/M combination with MS in pain control of patients suffering from isolated traumatic fracture of extremities.…”