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Efficacy of Adding Midazolam to Bupivacaine for Transversus Abdominis Plane Block on Postoperative Analgesia after Hysterectomy: A Randomized Controlled Study.
Anesth Essays Res 2019 Jul-Sep; 13(3):522-527AE

Abstract

Background and Aim

Different adjuncts have been utilized to promote the quality and prolong the duration of local anesthetics for a variety of regional block techniques. This study aimed to assess the effects of midazolam coadministered with bupivacaine in transversus abdominis plane (TAP) block on the 24-h morphine consumption, the postoperative analgesia duration and adverse effects.

Settings and Design

A prospective, randomized, controlled double-blind trial that was carried out at a university hospital.

Patients and Methods

Eighty-two females subjected to open total abdominal hysterectomy under general anesthesia were involved in this trial. Participants were allocated randomly to either of two groups (41 each). Control group: received TAP block with 20 mL of 0.25% bupivacaine or midazolam group: received TAP block using the same volume of bupivacaine plus 50 μg/kg midazolam/side. Postoperative cumulative 24-h morphine consumption, analgesia duration, pain score, sedation score, and adverse events were recorded.

Statistical Analysis

Student's t-test, Mann-Whitney U-test, and Chi-square test were used.

Results

Patients in the midazolam group had a lower cumulative 24-h morphine consumption [median doses (interquartile range): 15 (10-19.50) mg compared to 25 (17.50-37) mg, P < 0.001], lower postoperative pain score at rest at the 4th, 6th, and 12th h (P = 0.01, 0.02, and 0.02, respectively) and on movement at 2, 4, 6, and 12 h (P < 0.001), longer time till the first postoperative demand for rescue analgesia (430.11 ± 63.02 min) compared to 327.78 ± 61.99 min (P < 0.001), and less sedation, nausea and/or vomiting, and pruritus.

Conclusions

Adding midazolam as a bupivacaine adjuvant for TAP block reduces the 24-h morphine consumption, extends the postoperative analgesia duration, and decreases the incidence of adverse effects following abdominal hysterectomy.

Authors+Show Affiliations

Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt.Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt.Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt.Department of Obstetrics and Gynaecology, College of Medicine, Mansoura University, Mansoura, Egypt.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31602072

Citation

El Kenany, Samah, et al. "Efficacy of Adding Midazolam to Bupivacaine for Transversus Abdominis Plane Block On Postoperative Analgesia After Hysterectomy: a Randomized Controlled Study." Anesthesia, Essays and Researches, vol. 13, no. 3, 2019, pp. 522-527.
El Kenany S, Elshehawi ME, Farid AM, et al. Efficacy of Adding Midazolam to Bupivacaine for Transversus Abdominis Plane Block on Postoperative Analgesia after Hysterectomy: A Randomized Controlled Study. Anesth Essays Res. 2019;13(3):522-527.
El Kenany, S., Elshehawi, M. E., Farid, A. M., & Eid, M. I. (2019). Efficacy of Adding Midazolam to Bupivacaine for Transversus Abdominis Plane Block on Postoperative Analgesia after Hysterectomy: A Randomized Controlled Study. Anesthesia, Essays and Researches, 13(3), pp. 522-527. doi:10.4103/aer.AER_95_19.
El Kenany S, et al. Efficacy of Adding Midazolam to Bupivacaine for Transversus Abdominis Plane Block On Postoperative Analgesia After Hysterectomy: a Randomized Controlled Study. Anesth Essays Res. 2019;13(3):522-527. PubMed PMID: 31602072.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of Adding Midazolam to Bupivacaine for Transversus Abdominis Plane Block on Postoperative Analgesia after Hysterectomy: A Randomized Controlled Study. AU - El Kenany,Samah, AU - Elshehawi,Mohamed Eslam, AU - Farid,Ahmed Mohamed, AU - Eid,Mohamed Ibrahem, PY - 2019/10/12/entrez PY - 2019/10/12/pubmed PY - 2019/10/12/medline KW - Bupivacaine KW - midazolam KW - open abdominal hysterectomy KW - postoperative analgesia KW - transversus abdominis plane block SP - 522 EP - 527 JF - Anesthesia, essays and researches JO - Anesth Essays Res VL - 13 IS - 3 N2 - Background and Aim: Different adjuncts have been utilized to promote the quality and prolong the duration of local anesthetics for a variety of regional block techniques. This study aimed to assess the effects of midazolam coadministered with bupivacaine in transversus abdominis plane (TAP) block on the 24-h morphine consumption, the postoperative analgesia duration and adverse effects. Settings and Design: A prospective, randomized, controlled double-blind trial that was carried out at a university hospital. Patients and Methods: Eighty-two females subjected to open total abdominal hysterectomy under general anesthesia were involved in this trial. Participants were allocated randomly to either of two groups (41 each). Control group: received TAP block with 20 mL of 0.25% bupivacaine or midazolam group: received TAP block using the same volume of bupivacaine plus 50 μg/kg midazolam/side. Postoperative cumulative 24-h morphine consumption, analgesia duration, pain score, sedation score, and adverse events were recorded. Statistical Analysis: Student's t-test, Mann-Whitney U-test, and Chi-square test were used. Results: Patients in the midazolam group had a lower cumulative 24-h morphine consumption [median doses (interquartile range): 15 (10-19.50) mg compared to 25 (17.50-37) mg, P < 0.001], lower postoperative pain score at rest at the 4th, 6th, and 12th h (P = 0.01, 0.02, and 0.02, respectively) and on movement at 2, 4, 6, and 12 h (P < 0.001), longer time till the first postoperative demand for rescue analgesia (430.11 ± 63.02 min) compared to 327.78 ± 61.99 min (P < 0.001), and less sedation, nausea and/or vomiting, and pruritus. Conclusions: Adding midazolam as a bupivacaine adjuvant for TAP block reduces the 24-h morphine consumption, extends the postoperative analgesia duration, and decreases the incidence of adverse effects following abdominal hysterectomy. SN - 0259-1162 UR - https://www.unboundmedicine.com/medline/citation/31602072/Efficacy_of_Adding_Midazolam_to_Bupivacaine_for_Transversus_Abdominis_Plane_Block_on_Postoperative_Analgesia_after_Hysterectomy:_A_Randomized_Controlled_Study L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31602072/ DB - PRIME DP - Unbound Medicine ER -