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Comparative Studies | Anaesthesiology | India | Volume 12 Issue 12, December 2023

Comparative Study of Low Dose Intrathecal Midazolam and Fentanyl as an Adjuvant to Bupivacaine Heavy in Cesarean Section

Dr. Nidhi Kiran Maru | Dr. Yogita Patel | Dr. Dixita Vaghela | Dr. Sandip Prajapati | Dr. Lalenkawli Fanai

Abstract: Background and Aims: Although Bupivacaine has a short duration of action, it is the most used local anaesthetic for subarachnoid block in LSCS. Intrathecally administered adjuvants that are combined with bupivacaine lengthen post-operative analgesia and enhance blockade quality and duration. The study's main objective is to assess the post-operative analgesic durations of intrathecal midazolam with Bupivacaine heavy and intrathecal fentanyl with heavy bupivacaine. Evaluations of the motor and sensory characteristics, hemodynamic stability, APGAR score, and complications are secondary goals. Methods: After Ethical Committee approval, 76 patients following inclusion criteria, undergoing elective caeserian delivery under spinal anaesthesia were allocated randomly to 2 groups of 38 each using sealed envelope method: Group F-2ml Bupivacaine heavy (10mg)+0.25ml Fentanyl (12.5mcg); Group M-2ml Bupivacaine heavy (10mg)+0.2ml midazolam (1mg)+0.05ml normal saline. The sample size was determined after talking to the institutional review board and using the findings of our pilot trial, which included 5 patients in each group. After the procedure was finished, sensory and motor features, intraoperative hemodynamic stability, complications if any, and an assessment of pain every hour for the first 24 hours following the procedure were noted. Results: The average time of post-operative analgesia was 5.51+/-0.23 hours in group F and 5.06+/-0.40 hours in group M.Both groups' sensory and motor traits were comparable. When compared to group F, group M had sensory block earlier. Conclusion: For LSCS, fentanyl and midazolam are both effective adjuvants to hyperbaric bupivacaine in terms of hemodynamic stability and good APGAR score. When administered as an adjuvant in patients undergoing caesarean deliveries, intrathecal fentanyl offered superior post-operative analgesia versus midazolam.

Keywords: Hyperbaric Bupivacaine, Fentanyl, Midazolam

Edition: Volume 12 Issue 12, December 2023,

Pages: 454 - 457