Effects of Intrathecal Midazolam (1mg) with Hyperbaric Bupivacaine 0.5% (15mg) for Spinal Anesthesia for Caesarean Section

Abstract

Background: Intrathecal adjuvants are commonly used to enhance the efficacy of spinal anesthesia, particularly in cesarean sections. Midazolam, a benzodiazepine, has been studied for its potential analgesic and sedative effects when combined with local anesthetics. This study aims to evaluate the effects of intrathecal midazolam (1 mg) in combination with hyperbaric bupivacaine 0.5% (15 mg) for spinal anesthesia in cesarean section patients, assessing its impact on the duration of anesthesia, postoperative analgesia, hemodynamic stability, and adverse effects. Methods: A cross-sectional study was conducted at Qazi Hussain Ahmad Medical Complex, Nowshera, following approval from the institutional ethics committee. A total of 60 patients scheduled for elective cesarean section were included, with the sample size calculated using the WHO sample size calculator. Written informed consent was obtained from all participants. The study period spanned from June 2024 to December 2024. Key parameters assessed included the onset and duration of sensory and motor blockade, postoperative pain relief, hemodynamic changes, and the incidence of complications such as nausea, vomiting, hypotension, and sedation. Results: The two study group total number of participants 60 each group of 30, variables included age, weight, height and ASA physical status. The sensory block were study with Holleman’s scale, group BM sensory block onset time is (93%) more than group B that is (90%). Motor block were study by Bromage’s scale and greater in group BM (100%) and less in group B(90%). Midazolam had profound antiemetic effects, as nausea and vomiting were not observed in the group BM and observed in 33% of patients in the group B. The post-operative analgesia time was evaluated by the time of first rescue analgesia requirement.  The duration of post-operative analgesia was longer in the group BM (mean=67.93) compared to the group B (mean=28.34). Conclusion: Addition of midazolam with bupivacaine for intrathecal block enhanced the efficacy and effectiveness of sensory block and prolonged the post operative analgesia time. Post-operative complications were study in both groups. Intra-op and post-op nausea and vomiting in group BM (3.3%) and (13.3%) in group.