A Comparative Study of Intrathecal Levobupivacaine and Levobupivacaine with Midazolam in Lower Abdominal and Lower limb Surgeries
Journal Title: Indian Journal of Anesthesia and Analgesia - Year 2019, Vol 6, Issue 4
Abstract
Context: Intrathecal midazolam as an adjuvant to levobupivacaine provides excellent intraoperative hemodynamic stability and also good postoperative analgesia. Present study was done to evaluate the efficacy, duration of pain relief, the incidence of adverse effects and complications when midazolam is given along with levobupivacaine intrathecally. Aims: To compare between intrathecal levobupivacaine (Group LB) and intrathecal levobupivacaine with adjuvant midazolam 1 mg (Group LBM) with respect to onset and duration of analgesia, motor blockade, intraoperative discomfort and postoperative analgesia requirement and complications like nausea, vomiting, respiratory depression etc. Methodology: In this prospective, randomized, double blind, placebo controlled study a total of 100 patients of American Society of Anaesthesiologists (ASA) grade I and II, undergoing elective lower abdominal and lower limb orthopaedic surgery under sub-arachnoid block were randomized into two groups. Group LB (n=50) received 3 ml of 0.5% isobaric levobupivacaine with 0.2 ml of normal saline and Group LBM (n=50) received 3 ml of 0.5% isobaric levobupivacaine with 0.2 ml midazolam (1 mg) (preservative free) as intrathecal anesthesia. Assessment of sensory blockade, motorblockade, duration of analgesia, intraoperative hemodynamics, discomfort and postoperative analgesia estimated. After surgery, patients were asked to score their pain at 2, 4, 6, 12, 18 and 24 hr by VAS score. The presence of postoperative nausea vomiting (PONV), pruritus and respiratory depression were recorded and compared between the two groups. Statistical analysis: For continuous variables the summary statistics of N, mean, standard deviation (SD) were used. For categorical data,the number and percentage were used in data summaries.Chi-square(χ2)/ Fisher exact test was employed to determine the significance of differences between groups for categorical data. The difference of the means of analysis variables was tested with unpaired t-test. p-value <0.05 was considered significant. Data were analysed using SPSS software v.23.0. Results: Group LBM had superior quality of analgesia,prolonged duration of analgesia, reduced postoperative analgesic requirement and minimal hemodynamic changes compared to Group LB. Conclusions: Intrathecal midazolam potentiates levobupivacaine effect leading to better quality and longer duration of analgesia, better sedation, better postoperative outcome with minimum side effects.
Authors and Affiliations
Siddesh N Kadur
Keywords
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- EP ID EP668359
- DOI 10.21088/ijaa.2349.8471.6419.56
- Views 96
- Downloads 0
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