Shama Ahmed A, Ng Ka Ting, Shahen Moustafa M, Abosamak Mohammed F
Department of Anaesthesia and Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt.
Department of Anaesthesia, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Indian J Anaesth. 2022 Mar;66(3):200-206. doi: 10.4103/ija.ija_466_21. Epub 2022 Mar 24.
Avoidance of general anaesthesia for short-duration surgeries is a prerequisite, especially for children. Spinal anaesthesia is established as an appropriate anaesthetic procedure for this target. Midazolam has been proven to be safe for children as premedication. This study aimed to evaluate the effects of adding midazolam to intrathecal bupivacaine on intraoperative quality, duration of spinal anaesthesia and postoperative (PO) analgesia for children undergoing lower abdominal surgeries.
A prospective, comparative interventional study included 120 paediatric patients who were randomly divided into two groups that received intrathecal bupivacaine plus normal saline (B/S) or intrathecal bupivacaine plus midazolam (B/M). The efficacy of PO analgesia was assessed using the observational pain-discomfort scale (OPS). Duration of PO analgesia was measured, and recovery of motor block was assessed every 30 min till the Bromage scale reached 0. The level of PO sedation was assessed using the modified Wilson Sedation Score (WSS). Results were analysed using the one-way analysis of variance (ANOVA) test, Mann-Whitney test and Chi-square test.
Onset of sensory and motor blocks was significantly faster, and the frequency of patients having Bromage score of 3 within ≤10 min was significantly higher in group B/M than group B/S. Durations till sensory and motor recovery were significantly longer, the number of requests for PO analgesia was significantly lower and the mean of WSS was significantly higher at 30 and 120 min in group B/M than group B/S.
Intrathecal bupivacaine-midazolam combination significantly prolonged the duration of spinal anaesthesia and provided prolonged PO analgesia.
避免在短时间手术中使用全身麻醉是一个先决条件，尤其是对于儿童。脊髓麻醉已被确立为针对该目标的合适麻醉方法。咪达唑仑已被证明作为术前用药对儿童是安全的。本研究旨在评估鞘内注射布比卡因时添加咪达唑仑对接受下腹部手术儿童的术中质量、脊髓麻醉持续时间和术后镇痛的影响。
一项前瞻性、对比性干预研究纳入了120例儿科患者，他们被随机分为两组，分别接受鞘内注射布比卡因加生理盐水（B/S组）或鞘内注射布比卡因加咪达唑仑（B/M组）。使用观察性疼痛 - 不适量表（OPS）评估术后镇痛效果。测量术后镇痛持续时间，每30分钟评估一次运动阻滞恢复情况，直至 Bromage 量表达到0级。使用改良的威尔逊镇静评分（WSS）评估术后镇静水平。结果采用单因素方差分析（ANOVA）检验、曼 - 惠特尼检验和卡方检验进行分析。
B/M组感觉和运动阻滞的起效明显更快，且在≤10分钟内 Bromage 评分为3级的患者频率显著高于B/S组。B/M组感觉和运动恢复的持续时间显著更长，术后镇痛的需求次数显著更低，且在30分钟和120分钟时WSS的平均值显著高于B/S组。
鞘内注射布比卡因 - 咪达唑仑组合显著延长了脊髓麻醉的持续时间，并提供了更长时间的术后镇痛。
