Efficacy of intrathecal midazolam versus fentanyl for endoscopic urology surgery

Abstract

Background: This prospective randomized double-blind study was designed to compare the analgesic efficacy and safety of intrathecal midazolam versus fentanyl as an adjunct to bupivacaine for endoscopic urology surgery. Methods: Sixty adult ASA grade I-II patients undergoing transurethral resection of prostate or bladder tumor under spinal anesthesia were randomly allocated into three groups. Group B (control group) received 2 ml 0.5% hyperbaric bupivacaine while group BM received midazolam 2 mg and group BF received fentanyl 25 μg along with 2 ml of 0.5% bupivacaine in subarachnoid block. Postoperative analgesia was provided with intravenous diclofenac. The onset and duration of sensory and motor blockade, postoperative pain and the time to 1st rescue analgesia was noted. Patients were observed for hypotension, bradycardia, sedation, respiratory depression, pruritus, and postoperative nausea-vomiting. Results:The onset times and the duration of motor blockade were comparable among groups while the time to sensory block regression was longer in group BM and group BF as compared to group B (p < 0.001).The duration of postoperative analgesia was significantly prolonged in group BM and group BF as compared with group B (p < 0.001) while there was no difference between group BM and BF. The incidence of pruritus and vomiting was more in group BF. Conclusions: Addition of midazolam to intrathecal bupivacaine provides prolonged postoperative analgesia similar to intrathecal fentanyl and appears safe in patients undergoing endoscopic urology surgery.

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

“…10 Another study by Bharti et al, comparing intrathecal midazolam (2 mg) and fentanyl (25 µg) in endoscopic urological surgeries, proved that both offered similar advantages regarding duration of complete and effective analgesia postoperatively. 11 A similar comparison, performed by Elfawal et al, also confirmed the same results. 12 Several studies reported similar outcomes regarding the superiority of the analgesic effect of LA when adjuvants were added, but with various intergroup differences.…”

“…10 Also, Bharti et al, noted that regression of the sensory level to S2 segment was significantly delayed in the fentanyl and midazolam groups in comparison to the bupivacaine alone with comparable intergroup differences. 11 Duration of sensory and motor blocks was prolonged in fentanyl, nalbuphine and midazolam groups in comparison to bupivacaine alone with insignificant intergroup differences among adjuvants. These outcomes agree with other researchers who demonstrated similar outcomes.…”

A Comparative Study of the Effects of Intrathecal Midazolam and Fentanyl as Additives to Intrathecal Hyperbaric Bupivacaine (0.5%) for Spinal Anaesthesia

“…and in midazolam group, mean onset of sensory block was 223.6 sec. Similar values were obtained with regard to the onset of sensory block in midazolam group in the studies conducted by Nidhi Agrawal et al 11 in 2005 and Aikta Gupta et al 12 in 2008. There were no differences between the two groups with respect to the onset of block as significance value obtained from independent sample's t test was more than 0.05 (here it is 0.487).…”

Evaluating Effect of Prophylactic Intravenous Dexamethasone in Post Spinal Shivering: A Single Centre Randomised Controlled Study

“…Davoudi et al (2007) reported that a small dose of intrathecal pethidine is effective in decreasing shivering associated with spinal anaesthesia. 12 However, intrathecal opioid administration is relatively more invasive and carries risk of opioid side effects 13 .…”