A comparative study on post-operative analgesic effect by intrathecal midazolam and neostigmine with control group

Rashmi Dubey, Roseline Ali, Rashim Vachhani, Nishant Baghel


Background: Pain happens to be the most common suffering during postoperative period, which is not generally effectively treated. There is good evidence in literature that addition of midazolam to spinal bupivacaine improved postoperative analgesia when compared to spinal bupivacaine alone. Neostigmine represents a novel approach to providing analgesia. Recent studies showed that intrathecal administration of various doses of neostigmine produces analgesia without neurotoxicity. The present study was undertaken to evaluate analgesic effects of intrathecal Midazolam and neostigmine.

Methods: The present study was carried out in the department of anaesthesiology, CCM medical college, Durg Chhattisgarh, India during study period August 2015 to July 2016. The study comprised of 60 patients undergoing surgery of lower abdomen below umbilicus (T10) and lower limbs. Patients of age Group between 20-60 years of age of either sex of ASA group I and II were included in the study. Pre-anesthetic evaluation was done prior to surgery. The patients were randomly divided into 3 groups of 20 patients each. Data was compiled in MS excel and checked for its completeness and correctness, then it was analyzed.

Results: Mean age in Group I was 39.3+1.5 years. in Group II was 37.8±11.7 years, in Group III was 42.2±13.7 years. In group I maximum 14 patients (70%) had analgesia of less than 4 hours. Mean duration of analgesia was 3.73±0.87 hours. In group II maximum 18 patients (90%) had analgesia 4-8 hours. The mean duration of analgesia was 6.34±1.28 hours. In group III 10 patients (50%) had analgesia of 4-8 hours and 10 patients (50%) had analgesia of 8-12 hours. The mean duration was 8.35±1.36. The difference in VAS score in group in group I and group III is significant. There was no statistically significant change in systolic blood pressure, diastolic blood pressure, Pulse rate & respiratory rate attributable to intrathecal Midazolam and neostigmine.

Conclusions: Addition of preservative free midazolam to inteathecal bupivacaine prolongs duration of effective analgesia as compared to bupivacaine alone without any side effects. Addition of preservative free neostigmine to intrathecal bupivacaine prolongs duration of effective analgesia and sensory and motor block without any significant side effects.


Midazolam, Neostigmine, Pain, Post operation

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