Background: Dexmedetomidine and midazolam both modulate spinal analgesia by different
mechanisms, and yet, no human studies are available to compare them for postoperative analgesia
after neuraxial administration.
Objectives: We investigated the addition of dexmedetomidine or midazolam to intrathecal
bupivacaine on the duration of effective analgesia and clinical safety profile.
Study Design: Prospective, randomized, double blind, placebo controlled study.
Setting: University teaching hospital.
Methods: The study cohort included a consecutive and prospective series of patients, referred
for endourological procedures. The patients were randomly allocated into 3 groups (20 patients
each) to receive intrathecally 3 mL of 0.5% hyperbaric bupivacaine in combination with 5 mcg of
dexmedetomidine (dexmedetomidine group), 1 mg of midazolam (midazolam group) or 0.5 mL of
0.9% saline (control group). The groups were compared to the regression time of sensory block,
duration of effective analgesia (defined as the time interval between administration of intrathecal
drug to the time of first analgesic request or a numeric rating scale ≥ 4.0), sedation score, and side
effects in the first 24 hours.
Statistics: One way-ANOVA, Kruskal Wallis test, and Chi-square test (χ2), significance level: P < 0.05.
Results: The duration of effective analgesia (time to first analgesic request) was significantly
prolonged in the dexmedetomidine group (286 ± 64 minutes, P < 0.01) when compared with
midazolam group (236.9 ± 64.9 minutes) and the control group (212.7 ± 70.2 minutes). Pairwise
comparisons among the 3 groups with Bonferroni adjustment revealed that patients from the
dexmedetomidine group were more sedated in comparison to the midazolam and control groups at
the end of the first 15 minutes after intrathecal injection [χ2 (2) = 7.157, P = 0.028], with a mean
rank sedation score of 35.58 for dexmedetomidine, 25.00 for midazolam, and 30.93 for control.
No significant differences in the side effects were observed during the study period. Midazolam did
not lengthen the time of the two segment sensory regression or the time to first request analgesia.
Limitation: The study cannot be extrapolated to muscle cutting surgeries under spinal
anaesthesia.
Conclusions: The addition of dexmedetomidine (5 mcg) to 3 mL of intrathecal hyperbaric
bupivacaine (0.5%) significantly prolongs the duration of effective analgesia in comparison to
1 mg midazolam or placebo (0.9% normal saline) with a comparable incidences of side effects.
Key words: Dexmedetomidine, midazolam, intrathecal, spinal anaesthesia, subarachnoid block,
postoperative pain
Pain Physician 20