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Efficacy of adding midazolam to bupivacaine for transversus abdominis plane block on postoperative analgesia after hysterectomy: A randomized controlled study


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

Correspondence Address:
Samah El Kenany,
Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura
Egypt
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aer.AER_95_19

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.


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    -  El Kenany S
    -  Elshehawi ME
    -  Farid AM
    -  Eid MI
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