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Analgesic Efficacy of Two Doses of Intrathecal Midazolam With Bupivacaine in Patients Undergoing Cesarean Delivery
  1. Smita Prakash, M.D.,
  2. Nandita Joshi, M.D.,
  3. Anoop R. Gogia, M.D.,
  4. Sunil Prakash, D.M. and
  5. Rajvir Singh, Ph.D.
  1. From the Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College & Safdarjang Hospital, New Delhi, India
  2. Northern Railway Central Hospital, New Delhi, India
  3. All India Institute of Medical Sciences, New Delhi, India.
  1. Reprint requests: Smita Prakash, M.D., 155/3 Basant Lane, Railway Colony, New Delhi 110055, India.. E-mail: drsunilprakash{at}


Objectives: In this prospective, randomized, double-blind, placebo-controlled study, we investigated the postoperative analgesic efficacy of 2 doses of intrathecal midazolam as an adjunct to bupivacaine for spinal anesthesia.

Methods: Sixty patients undergoing elective cesarean delivery under spinal anesthesia were allocated randomly to 3 groups: group B, 2 mL hyperbaric bupivicaine 0.5%; group BM1, 2 mL bupivacaine plus midazolam 1 mg (preservative free); and group BM2, 2 mL bupivicaine plus midazolam 2 mg.

Results: The mean duration of postoperative analgesia (determined by request for rescue medication) was 3.8 ± 0.5 hours in group B compared with 4.3 ± 0.7 hours in group BM1 (P = .18), and 6.1 ± 1.0 hours in group BM2 (P = .001). Supplemental analgesic requirements with diclofenac were significantly less in group BM2 (93 ± 29 mg) compared with group B (145 ± 12 mg) and group BM1 (148 ± 16 mg, P < .001). Time to block regression was longer in group B (182 ± 30 minutes) compared with group BM1 (152 ± 32 minutes) and group B (126 ± 20 minutes) (both P < .001). Arterial pressure, heart rate, oxygen saturation, sedation score, and time to first void were comparable between groups. Group B had a significantly higher incidence of nausea and vomiting than groups BM1 and BM2 (P = .02). No neurologic deficits were observed.

Conclusions: Intrathecal midazolam 2 mg provided a moderate prolongation of postoperative analgesia when used as an adjunct to bupivacaine in patients undergoing cesarean delivery. Intrathecal midazolam, 1 mg and 2 mg, decreased postoperative nausea and vomiting.

  • Analgesia
  • Obstetric
  • Postoperative
  • Anesthetic techniques
  • Intrathecal
  • Anesthetics
  • Local
  • Bupivacaine
  • Analgesics
  • Midazolam

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