A comparative study of efficacy and safety of intrathecal midazolam plus bupivacaine versus bupivacaine in sub-arachnoid block for cesarean section

Abstract

Introduction: Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia. Several adjuvants have been tried along with local anesthetic for prolonging the duration of analgesia. Aim: To study the bupivacaine sparing effect of intrathecal midazolam in sub-arachnoid block for cesarean section Materials and methods: A hospital-based interventional study 100 Patients scheduled for elective cesareansection . From the study population two groups of 50 each were observed to assess the selected parameters. Group B - receiving 2 cc of 0.5%Hyperbaric Bupivacaine (10mg) intrathecal Group BM- receiving 1.6 cc of 0.5%Hyperbaric Bupivacaine (8mg) + 0.4cc of 0.5% preservative free midazolam (2mg) intrathecal. Onset times of sensory and motor blockade, duration of sensory and motor blockade, duration of effective analgesia, Ramsay sedation score, newbornAPGAR score and side effects were recorded. Results:. Duration of sensory block is signifcantly high in group BM when compared to Group-B. Duration of effective analgesia is significantly high in Group BM than that of Group-B. There is a statistically significant difference (p-value< 0.05) in the incidence of hypotension between the 2 groups with patients receiving midazolam in combination with low-dose bupivacaine having significantly lesser incidence of hypotension. Comparing nausea/vomiting between the groups the result is statistically significant at p<0.05. APGAR scores of the newborns were comparable between the groups and there was no statistically significant difference. Conclusion: Intrathecal midazolam as an adjuvant to Bupivacaine is safe and effective.