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COMPARISON OF THE ANALGESIC EFFECT OF INTRATHECAL FENTANYL AND MIDAZOLAM
ABSTRACT
The spinal route of analgesia has consolidated its place as a major modality in the treatment of acute, chronic and cancer pain because the spinal cord represents a principal target in the modulation of pain impulses from the periphery as well as the brain. This makes it important in the management of pain. The use of 0.5% heavy bupivacaine in combination with fentanyl or midazolam has been reported to provide excellent and superior analgesia of longer duration during surgical procedures.1,2 This combination has the added advantage of reduced side effects in the perioperative period compared to when any of these drugs is used singly as monotherapy.
This study is designed to determine the quality of analgesia provided by the intrathecal administration of fentanyl 25µg or midazolam 2mg in combination with 10mg of 0.5% heavy bupivacaine compared with single administration of 10mg 0.5% heavy bupivacaine alone as control in adult patients undergoing open reduction and internal fixation of lower limb fractures. The total post operative analgesic consumption of patients in 24 hours following surgery as well as the incidence and severity of any undesirable effect were studied
The study groups comprise patients receiving intrathecal fentanyl 25µg with 10mg 0.5% heavy bupivacaine(FB group) or midazolam 2mg with 10mg 0.5% heavy bupivacaine(MB group) for analgesia in adult patients undergoing open reduction and internal fixation for lower limb fractures .The control group(B group) were patients receiving neuraxial 10mg 0.5% heavy bupivacaine alone. A total of fifty (50) patients, American Society of Anaesthesiologists (ASA) I and II xiv status requiring open reduction and internal fixation of lower limb fracture under subarachnoid blocks were studied.
The mean duration of analgesia / neural blockade in the control group (B) was 2.37(±0.30) hours; 4.73(±0.89) hours in the fentanyl – bupivacaine (FB) group and 5.04(±0.99) hours in the midazolam – bupivacaine (MB) group. Two patients (11.8%) in the fentanyl – bupivacaine( FB ) group had pruritus (p = 0.132) while pruritus was absent in the other two groups. Two patients (11.8%) in the
fentanyl – bupivacaine (FB ) group, one patient in the control group (5.9%) and none in the midazolam – bupivacaine ( MB ) group vomited (p = 0.364 ) It was found from this study that both intrathecal midazolam and fentanyl potentiate the analgesic effect of 0.5% hyperbaric bupivacaine. Midazolam bupivacaine combination however offers a better side effect profile than fentanyl – bupivacaine.
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