oa Southern African Journal of Anaesthesia and Analgesia - Efficacy of intrathecal midazolam versus fentanyl for endoscopic urology surgery : research
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 Iâ??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.
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