Department of Anaesthesiology, All India Institute of Medical Scences, Ansari Nagar, New Delhi 110029, India.
Singapore Med J. 2011 Jun;52(6):432-5.
Subarachnoid block with local anaesthetics and adjuvants has been extensively used for surgery. Intrathecal midazolam produces antinociception and potentiates the effect of local anaesthetics. We compared intrathecal bupivacaine with and without midazolam to assess its effect on the duration of sensory block, motor block and pain relief.
A total of 100 patients scheduled for elective lower abdominal, lower limb and gynaecological procedures were selected to participate in this prospective, randomised, double-blind study. Patients were randomly allocated into two groups for intrathecal drug administration. Group B received 3 mL 0.5 percent bupivacaine with 0.4 mL saline, and group BM received 3 mL 0.5 percent bupivacaine and 0.4 mL (2 mg) midazolam mixture. The onset, duration of sensory/motor block, time to first rescue analgesia and side effects were noted.
Demographic profile and duration of surgery were comparable between the two groups. The onset of sensory (4.8 versus 4.6 min) and motor block (5.9 versus 6 min) was also comparable between the groups. The duration of sensory blockade was prolonged in the midazolam group (90.8 versus 115.8 min, p-value is 0.001), while the duration of motor blockade was comparable (151.8 versus 151.3 min, p-value is 0.51). The duration of effective analgesia was significantly longer in the midazolam group compared to the control group (121.3 versus 221.1 min, p-value is 0.001). Sedation score was comparable in the two groups.
The addition of preservative-free midazolam to bupivacaine intrathecally resulted in prolonged postoperative analgesia without increasing motor block.
蛛网膜下腔阻滞联合局部麻醉药和佐剂已广泛应用于手术。鞘内咪达唑仑具有镇痛作用，并增强局部麻醉药的效果。我们比较了鞘内布比卡因加用和不加用咪达唑仑，以评估其对感觉阻滞、运动阻滞和止痛效果的影响。
选择 100 例拟行下腹部、下肢和妇科手术的患者参与这项前瞻性、随机、双盲研究。患者被随机分为两组鞘内药物给药。B 组给予 3 毫升 0.5%布比卡因加 0.4 毫升生理盐水，BM 组给予 3 毫升 0.5%布比卡因加 0.4 毫升（2 毫克）咪达唑仑混合液。记录起效时间、感觉/运动阻滞持续时间、首次解救性镇痛时间和不良反应。
两组患者的人口统计学特征和手术时间无差异。两组感觉（4.8 分钟比 4.6 分钟）和运动阻滞（5.9 分钟比 6 分钟）的起始时间也相似。咪达唑仑组的感觉阻滞持续时间延长（90.8 分钟比 115.8 分钟，p 值为 0.001），而运动阻滞持续时间无差异（151.8 分钟比 151.3 分钟，p 值为 0.51）。咪达唑仑组的有效镇痛时间明显长于对照组（121.3 分钟比 221.1 分钟，p 值为 0.001）。两组镇静评分相似。
鞘内给予不含防腐剂的咪达唑仑可延长术后镇痛时间，而不增加运动阻滞。
