Ho K M, Ismail H
Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia, Australia.
Anaesth Intensive Care. 2008 May;36(3):365-73. doi: 10.1177/0310057X0803600307.
Intrathecal midazolam binds with gamma aminobutyric acid-A receptors in the spinal cord leading to an analgesic effect. Clinical studies suggested that intrathecal midazolam may also reduce nausea and vomiting when used as an adjunct to other spinal medications. However, the potential neurotoxic effect of intrathecal midazolam remains a concern. This meta-analysis aims to evaluate the effectiveness and side-effects of intrathecal midazolam in the perioperative and peripartum settings. Thirteen randomised controlled studies from MEDLINE (from 1966 to July 1, 2007), EMBASE and Cochrane Controlled Trials Register databases, involving a total of 672 patients, were considered. Volunteer, animal and chronic pain studies were excluded. Adding intrathecal midazolam to other spinal medications reduced the incidence of nausea and vomiting (odds ratio 0.50, 95% confidence interval [CI] 0.27 to 0.90, P=0.02; I2=4%) and delayed the time to request for rescue analgesia (weighted-mean-difference=98.7 min, 95% CI: 76.1 to 121.4, P<0.00001; I2=98.5%). Intrathecal midazolam did not affect the duration of motor blockade (weighted-mean-difference =25.1 min, 95% CI -7.6 to 57.8, P=0.13, I2=94.8%). The incidence of neurological symptoms after intrathecal midazolam was uncommon (1.8%) and did not differ from placebo (odds ratio 1.20, 95% CI 0.22 to 6.68, P=0.84). Based on the limited data available, intrathecal midazolam appears to improve perioperative analgesia and reduce nausea and vomiting during caesarean delivery. A multicentre registry or large randomised controlled study with a prolonged follow-up period would be useful to confirm the clinical safety of intrathecal midazolam.
鞘内注射咪达唑仑与脊髓中的γ-氨基丁酸-A受体结合，从而产生镇痛效果。临床研究表明，鞘内注射咪达唑仑作为其他脊髓用药的辅助药物时，还可能减轻恶心和呕吐。然而，鞘内注射咪达唑仑潜在的神经毒性作用仍是一个令人担忧的问题。这项荟萃分析旨在评估鞘内注射咪达唑仑在围手术期和围产期的有效性及副作用。研究纳入了MEDLINE（1966年至2007年7月1日）、EMBASE和Cochrane对照试验注册数据库中的13项随机对照研究，共计672例患者。志愿者、动物和慢性疼痛研究被排除在外。在其他脊髓用药中添加鞘内注射咪达唑仑可降低恶心和呕吐的发生率（比值比0.50，95%置信区间[CI] 0.27至0.90，P = 0.02；I2 = 4%），并延迟了请求补救镇痛的时间（加权平均差 = 98.7分钟，95% CI：76.1至121.4，P < 0.00001；I2 = 98.5%）。鞘内注射咪达唑仑不影响运动阻滞的持续时间（加权平均差 = 25.1分钟，95% CI -7.6至57.8，P = 0.13，I2 = 94.8%）。鞘内注射咪达唑仑后神经症状的发生率较低（1.8%），与安慰剂无差异（比值比1.20，95% CI 0.22至6.68，P = 0.84）。基于现有有限的数据，鞘内注射咪达唑仑似乎可改善围手术期镇痛，并减少剖宫产期间的恶心和呕吐。一项多中心注册研究或长期随访的大型随机对照研究将有助于确认鞘内注射咪达唑仑的临床安全性。
