Comparative Study of Ketamine and Fentanyl When Added to Intrathecal Bupivacaine on Sensory and Motor Blockade in Patients Undergoing Total Abdominal Hysterectomy

Introduction:- Ketamine and Fentanyl used intrathecally as adjuvant to 0.5% hyperbaric bupivacaine for patients undergoing TAH to shorten the onset of sensory and motor blockade and prolonging the duration of block. Aims and Objective:-We evaluated onset and duration of sensory and motor blockade and timing of regression of sensory blockade to T 12 and motor blockade to Bromage scale 3. Material and Methods:-This analytical Comparative Study was conducted in Department of Anaesthesiology, Era’s Lucknow Medical College and Hospital, Era University, Lucknow over a period of eighteen months from 2016 -2018 following approval from institutional ethical committee and written informed patient consent. The sample size of 162 female patient aged 40 to 60 years, belonging to ASA physical status 1 and 2 undergoing TAH were randomly allocated to three groups in double blind manner. Group I Received Inj. Bupivacaine (0.5% Heavy) 3.0ml + Inj. Ketamine (25 mg), Group II Received Inj. Bupivacaine (0.5% Heavy) 3.0 ml + Inj. Fentanyl (25 µgm), Group III (Control Group): Received Inj. Bupivacaine (0.5% Heavy) 3.0 ml + Normal saline 0.5 ml. Onset and Duration of Sensory and Motor Blockade and time taken for regression of sensory level to T12 and motor level to Bromage scale 3 noted. Results:- The present study showed that both Ketamine as well as Fentanyl shortened the onset time and prolonged the block duration. However, with respect to onset time, ketamine has shorter onset of blockade than fentanyl. Conclusion:- Both the modalities independently assured quicker onset and prolonged duration of block, thus suggesting that adjuvant use of either of two could be beneficial. Keywords: TAH, Ketamine, Fentanyl, Bupivacaine.

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Comparision of dexmedetomidine and clonidine with hyperbaric bupivacain in spinal anaesthesia

International Surgery Journal ◽

10.18203/2349-2902.isj20214746 ◽

2021 ◽

Vol 8 (12) ◽

pp. 3563

Author(s):

Anshul Agrawal ◽

Sunita Jain ◽

Ashish Goyal

Keyword(s):

Spinal Anaesthesia ◽

Onset Time ◽

Peak Level ◽

Sensory Block ◽

Double Blind Study ◽

Motor Blockade ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Sensory Blockade ◽

Lower Limb Surgery

Background: Alpha-2 adrenergic agonists used as adjuvant to spinal anaesthesia produce substantial sensory and motor blockade of bupivacaine. This study was planned to compare the sensory and motor blockade characteristics of intrathecal combinations of adjuvants dexmedetomidine and clonidine with hyperbaric bupivacaine in the cases who underwent lower limb surgery under spinal anaesthesia.Methods: This was prospective, randomized, double blind study. 90 patients of age group between 18-60 years, ASA grade I and II were allotted into 3 equal groups. Group B received 15 mg bupivacaine plain, group BD and BC received dexmedetomidine (5mcg) and clonidine (50mcg) as adjuvants to bupivacaine respectively.Results: The duration of 2 dermatome regression time, sensory blockade and motor blockade were longest in dexmedetomidine group (129.37±4.87; 386±58.43; 353±48.87) in compared to clonidine (109.77±5.95; 296.53±57.19; 269.7±51.2) and bupivacaine group (81.03±6.83; 211.1± 30.47;181.03±20.8). Both drugs do not affect the peak level of sensory blockade, sensory block onset and motor block onset time. Dexmedetomidine and clonidine do not cause sedation in intraoperative and postoperative period.Conclusions: We conclude that addition of dexmedetomidine and clonidine in spinal anesthesia with hyperbaric bupivacaine increase the duration of ‘2 dermatome regression’ time, sensory and motor blockade and both are more with dexmedetomidine than with clonidine.

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Clonidine as an adjuvant to bupivacaine in spinal anaesthesia for infra-umbilical surgeries in children: a prospective randomized, double-blind trial

Ghana Medical Journal ◽

10.4314/gmj.v55i2.2 ◽

2021 ◽

Vol 55 (2) ◽

pp. 103-110

Author(s):

Geeta Kamal ◽

Raman Piplani ◽

Anju Gupta ◽

Nidhi Sehgal

Keyword(s):

Spinal Anaesthesia ◽

Randomized Study ◽

Tertiary Care ◽

Saline Group ◽

Control Group ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Duration Of Action ◽

Sensory Blockade ◽

Group I

Objective: Spinal anaesthesia (SA) is a well-established technique for infra-umbilical surgeries but is underutilized in children. One important reason is the limited duration of action. Clonidine is a useful adjuvant in this regard but has not been studied in a dose of 1.5 μg/kg.Design: a prospective randomized study Setting: A single centre study conducted at a Super speciality paediatric tertiary care centre.Participants: Sixty children (5-12yrs) scheduled for lower abdominal surgery with duration <90min were included.Interventions: The participants were randomized into two groups to receive 0.4mg/kg of 0.5% hyperbaric bupivacaine with clonidine 1.5μg/kg (Group-I, n=30) or 0.4mg/kg of 0.5% hyperbaric bupivacaine with saline(Group-II, n=30) in the subarachnoid block.Main outcome measures: The sensory and motor block duration, time to two-segment regression, time to first rescue analgesic, and the number of rescue doses required were recorded.Results: Mean duration of sensory blockade (147.5±7.28 vs 310.33±10.17min; P<0.001) and motor blockade (132.5±10.06 vs 283.33±11.77min; P < 0.001) and duration of analgesia (172±9.61 vs 364.50±28.75min; P < 0.001) were significantly prolonged in the clonidine group. In the control group, most patients needed three analgesic doses over 24hr while in the clonidine group, the majority needed two doses. Adverse effects were infrequent in both groups.Conclusions: Clonidine as an adjuvant to 0.5% hyperbaric bupivacaine significantly prolonged the duration of analgesia with improved quality of anaesthesia while maintaining safety. We recommend the routine use of clonidine 1.5 μg/kg dose as an adjuvant to 0.5% bupivacaine in paediatric SA.

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A Comparative Study of Addition of Midazolam to Lignocaine—Bupivacaine vs only Lignocaine— Bupivacaine in Brachial Plexus Block

Research & Innovation in Anesthesia ◽

10.5005/jp-journals-10049-0002 ◽

2016 ◽

Vol 1 (1) ◽

pp. 5-9

Author(s):

Naina P Dalvi ◽

Harshali Salunkhay ◽

Shubha N Mohite

Keyword(s):

Comparative Study ◽

Brachial Plexus ◽

Brachial Plexus Block ◽

Control Group ◽

Study Group ◽

Motor Blockade ◽

Peripheral Nerve Stimulator ◽

Sensory Blockade ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block

ABSTRACT Introduction This prospective, randomized, double-blind study compared the onset and duration of sensory blockade, motor blockade, and analgesia with lignocaine, bupivacaine, and midazolam combination vs only lignocaine, bupivacaine in brachial plexus block. Materials and methods Patients of either sex, aged 18–60 years, American Society of Anesthesiologists grade I/II, posted for upper limb surgeries to be performed under supraclavicular brachial plexus block with the help of peripheral nerve stimulator were administered either 10 ml 0.5% bupivacaine with 50 μg/kg midazolam (preservative free) + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine– bupivacaine–midazolam (LBM) or 10 ml 0.5% bupivacaine + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine–bupivacaine (LB). Onset and duration of sensory and motor blockade were monitored. Postoperative analgesia was graded with visual analog scale. Sedation was monitored with Ramsey sedation score. Results A total of 60 patients were randomized to the group LBM (n = 30) and group LB (n = 30). The analgesia was significantly prolonged in the study group, with a mean of 11.72 ± 1.924 hours as compared with a mean of 6.383 ± 1.031 hours in the control group. Sedation scores were higher in the study group, that is, group LBM compared to group LB postoperatively. Conclusion In conclusion, midazolam when added to bupivacaine and adrenalized lignocaine for supraclavicular brachial plexus block hastens the onset of sensory and motor blockade. This combination improves analgesia, as manifested by lower pain scores and prolonged duration of analgesia. How to cite this article Dalvi NP, Salunkhay H, Mohite SN. A Comparative Study of Addition of Midazolam to Lignocaine–Bupivacaine vs only Lignocaine–Bupivacaine in Brachial Plexus Block. Res Inno in Anaesth 2016;1(1):5-9.

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Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries

Research & Innovation in Anesthesia ◽

10.5005/jp-journals-10049-0010 ◽

2016 ◽

Vol 1 (2) ◽

pp. 35-40 ◽

Cited By ~ 2

Author(s):

Naina P Dalvi ◽

Narendra Patil

Keyword(s):

Blood Pressure ◽

Postoperative Analgesia ◽

Total Duration ◽

Double Blind Study ◽

Motor Blockade ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Sensory Blockade ◽

Prolonged Duration ◽

American Society

ABSTRACT Introduction This single-center, prospective, randomized, double-blind study compares the effect of intrathecal fentanylbupivacaine and tramadol-bupivacaine on the onset and duration of sensory and motor blockade, as well as postoperative analgesia in lower abdominal surgeries. Materials and methods Patients of either sex, aged 18 to 60 years, American Society of Anesthesiologists (ASA) grade I/II undergoing lower abdominal surgeries like appendicectomy, inguinal hernia repair surgery, and hydrocele surgery were administered either 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 μg) of fentanyl citrate (group F) or 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 mg) of tramadol (group T) intrathecally. Monitoring of the vital parameters, onset and duration of sensory and motor block, duration of postoperative analgesia, visual analog scale (VAS) score, sedation score, and any adverse drug reactions was done at predetermined intervals. Results Sixty patients were randomized to the group F (n = 30) and group T (n = 30). The duration of sensory blockade was significantly prolonged in group F (314.66 ± 49.25 minutes) as compared to group T (261.66 ± 27.92 minutes). Similarly, duration of motor blockade was longer in group F (263.66 ± 40.97 minutes) compared to group T (214.66 ± 26.61 minutes). The total duration of analgesia was significantly prolonged (p < 0.001) in group F (412 ± 97.888 minutes) compared to group T (301 ± 38.75 minutes). Hemodynamic parameters, such as pulse, systolic blood pressure, diastolic blood pressure and oxygen saturation were comparable in both the groups. Visual analog scores were significantly lower in the group F patients as compared to the group T patients. The group F patients had got significantly higher sedation scores as compared to Group T patients. Discussion Fentanyl 25 μg, when added to 2.5 mL of 0.5% hyperbaric bupivacaine, confers prolonged duration of sensory and motor blockade than 25 mg tramadol added to 2.5 mL of 0.5% hyperbaric bupivacaine. The bupivacaine-fentanyl combination prolonged duration of sensory and motor blockade, improved analgesia, as manifested by lower pain scores, and prolonged duration of postoperative analgesia. How to cite this article Dalvi NP, Patil N. Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries. Res Inno in Anesth 2016;1(2):35-40.

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A comparative study of intrathecal bupivacaine and levobupivacaine for patients undergoing caesarean section

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20195229 ◽

2019 ◽

Vol 6 (6) ◽

pp. 1792

Author(s):

Kiranpreet Kaur ◽

Sanjay Johar ◽

Anil Kumar ◽

Mamta Jain ◽

Prashant Kumar ◽

...

Keyword(s):

Caesarean Section ◽

Onset Time ◽

Sensory Block ◽

P Value ◽

Motor Blockade ◽

Hyperbaric Bupivacaine ◽

Sensory Blockade ◽

Pregnant Females ◽

Haemodynamic Stability ◽

Group B

Background: The present study was conducted to compare the effects of 0.5% isobaric levobupivacaine and 0.5% hyperbaric bupivacaine in pregnant females undergoing caesarean section.Methods: Study was conducted on 100 pregnant females undergoing caesarean section. They were randomly divided into two groups B and L receiving 2 ml of 0.5% hyperbaric bupivacaine and 0.5% levobupivacaine respectively. Two groups were compared with regard to sensory block, motor block, haemodynamic stability and complications if any.Results: Time to achieve sensory blockade till T6 dermatome was prolonged in group B (162.52±80.55 sec) as compared to group L (139.40±49.79 seconds) (p value= 0.087). Prolonged duration of motor blockade was observed in group B (160.76±6.56 minutes) as compared to group L (131.48±14.42 minutes) (p<0.001). Less haemodynamic stability was seen in patients of group B with more incidence of hypotension and bradycardia.as compared to group L.Conclusions: Levobupivacaine is nearly equally effective to bupivacaine to produce sensory and motor blockade with comparable onset time and better haemodynamic stability with lesser side effects.

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Comparison of dexmedetomidine and buprenorphine as an adjuvant to bupivacaine during spinal anaesthesia for tibial interlocking nailing surgeries

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20175184 ◽

2017 ◽

Vol 4 (6) ◽

pp. 1653

Author(s):

Amitha S. ◽

Pradeep R.

Keyword(s):

Spinal Anesthesia ◽

Spinal Anaesthesia ◽

Motor Blockade ◽

Hyperbaric Bupivacaine ◽

Chi Square ◽

Double Blind ◽

Sensory Blockade ◽

Exact Test ◽

Interlocking Nailing ◽

Group 3

Background: Buprenorphine is being used as an adjuvant to local anaesthetic for spinal anaesthesia since long. Dexmedetomidine is a new drug which has got alpha 2 agonistic property, and is being tried for spinal anesthesia along with bupivacaine in recent times. Settings and Design: This study was conducted in a prospective, randomized, controlled and double-blind manner. The study included ninety American Society of Anaesthesiologists class I and II patients undergoing tibial interlocking nailing surgeries under spinal anaesthesia.Methods: The patients were randomly divided into three groups (n=30 each) by closed envelope technique. Patients in group 1 received 15 mg of 0.5% hyperbaric bupivacaine, group 2 received 15 mg of 0.5% hyperbaric bupivacaine with 30μg of buprenorphine, and group 3 received 15 mg of 0.5% hyperbaric bupivacaine with 5μg dexmedetomidine for spinal anesthesia. The duration of motor and sensory blockade and any adverse events were recorded. Data were analysed using Chi-square test or Fisher’s exact test for categorical data and analysis of variance for continuous data. A value of P<0.05 was considered as statistically significant.Results: In our study the subjects in group 3 (dexmedetomidine) group had significantly longer period of motor blockade (240±20min) and sensory blockade (180±22.2min) compared to other groups, which is statistically significant (P=0.0001 and P= 0.006 respectively). The time to first request of analgesic in the post-operative period was also longer (240±30.2min) in dexmedetomidine group when compared with other groups (P=0.0001). There were no untoward complications (hypotension, sedation) in any groups.Conclusions: We concluded that dexmedetomidine (5μg) with bupivacaine for spinal anesthesia gives significantly longer duration of sensory and motor blockade, than buprenorphine (30μg) with bupivacaine for spinal anaesthesia.

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COMPARATIVE STUDY OF INTRATHECAL FENTANYL WITH HYPERBARIC BUPIVACAINE TO IMPROVE PERIOPERATIVE ANALGESIA IN PATIENT UNDERGOING ORTHOPEDIC SURGERY

10.36106/paripex/5801902 ◽

2021 ◽

pp. 55-58

Author(s):

Rahul Wagh ◽

Swapnil Sangale ◽

Nagesh Jambure

Keyword(s):

Side Effects ◽

Lower Limb ◽

Motor Block ◽

Control Group ◽

Study Group ◽

Hyperbaric Bupivacaine ◽

Analgesic Requirement ◽

Sensory Blockade ◽

Group I ◽

Group Ii

Background: Various methods exist for treating post-operative pain which includes systemic narcotics, NSAIDS, patient-controlled analgesia, regional anaesthesia techniques, epidural local anaesthetic – narcotic mixtures, cryoanalgesia, transcutaneous electric nerve stimulation, psychological methods. Various opioides intrathecally and epidurally have been tried for post-operative analgesia. These include - morphine, pethidine, pentazocine, methadone, tramadol, Fentanyl, sufentanyl. In present study, we tried to find out analgesic effectiveness of intrathecal Fentanyl for post-operative analgesia, combined with 0.5 % Bupivacaine and side effects if any, in patients undergoing lower limb surgeries. Materials and Methods: After approval from the local ethics committee and with written informed consent from patient, a randomized controlled prospective study is carried out in the medical college and hospital.100 patients belonging to American Society of Anesthesiologists (ASA)classification I & II, aged between 18-60 years, posted for elective lower limb surgeries, were randomly allocated for the study. Group-I: 50 patients received intrathecal 3 ml of 0.5 % hyperbaric Bupivacaine only. Group-II : 50 patients received intrathecal 3 ml of 0.5% hyperbaric Bupivacaine and Fentanyl 25 mcg.The patients studied across the group did not vary much with respect to age,height, weight and sex distribution. Results: The onset of sensory blockade was faster by 1.27 min in Group-BF. The perioperative and postoperative hemodynamic parameters were comparable in both the groups. The sensory analgesia in Group II was significantly prolonged by 159 mins, thus increasing the duration of analgesia. The time of first request of analgesics by the patients in group-II is prolonged compared to group-I thus prolonging the duration of analgesia. Analgesic requirement is also reduced in study group in early post-operative period. The onset of motor block was faster when Fentanyl was added to intrathecal Bupivacaine and it was 1.1 min earlier in study group. The duration of motor block to Bromage III was prolonged by almost 22 min in study group as compare to control group. Visual analogue scores were significantly lower in group-II compared to group-I after two hours of surgery thus reducing the frequency of supplemental postoperative analgesics. Conclusion: With the present study we can summarize that intrathecal Fentanyl potentiates the action of Bupivacaine thereby bringing about better quality and longer duration of analgesia, intense motor block, no hemodynamic disturbance and better postoperative outcome with/ minimum side effects.

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Extent of Hyperbaric Spinal Anesthesia Influences the Duration of Spinal Block

Anesthesiology ◽

10.1097/00000542-200005000-00020 ◽

2000 ◽

Vol 92 (5) ◽

pp. 1319-1323 ◽

Cited By ~ 17

Author(s):

Nicoline E. Kooger Infante ◽

Elizabeth Van Gessel ◽

Alain Forster ◽

Zdravko Gamulin

Keyword(s):

Spinal Anesthesia ◽

Spinal Block ◽

Sensory Level ◽

Motor Blockade ◽

Hyperbaric Bupivacaine ◽

Sensory Blockade ◽

Operative Site ◽

Lower Limb Surgery ◽

American Society ◽

American Society Of Anesthesiologists

Background The influence of spread of spinal anesthesia on the duration of spinal blockade has been suggested but never investigated specifically. Because elimination of local anesthetic from subarachnoid space is probably dependent of the surface available for its diffusion and vascular absorption, the current study was designed to evaluate the hypothesis that with a same dose of hyperbaric bupivacaine, a higher anesthetic level would result in a shorter duration of spinal blockade than a lower level. Methods Three milliliters (15 mg) of hyperbaric bupivacaine, 0.5%, was injected intrathecally in 40 patients classified as American Society of Anesthesiologists physical status I or H scheduled for lower limb surgery during spinal anesthesia. To obtain significantly different anesthetic levels, the patients were positioned randomly either horizontally or with the torso elevated 30. Regression of sensory level and motor blockade, the appearance of pain at the operative site, and hemodynamic changes were evaluated. Results The maximum cephalad spread of sensory blockade (expressed as the median with ranges in parentheses) was significantly higher in the horizontal group than in the group with 30-degree elevation of the torso, i.e., T3.5 (T1-T9) versus T10 (T6-L1), with respectively significantly faster regression times (mean ¿ SD) by two segments (216 ¿ 46 mm vs. 253 ¿ 64 mm) and to segment L4 (269 ¿ 53 mm i s. 337 ¿ 58 mm), as well as shorter time to complete motor blockade recovery (173 ¿ 34 mm i s. 233 ¿ 58 mm) and faster appearance of pain at the operative site (221 ¿ 68 mm vs. 271 ¿ 56 mm). Conclusion The results indicate that with the same dose of hyperbaric bupivacaine, the duration of spinal blockade is longer in patients with restricted spread.

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Comparative study of hyperbaric 0.5% bupivacaine and hyperbaric 0.5% bupivacaine with low dose dexmedetomidine in spinal anaesthesia

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20170339 ◽

2017 ◽

Vol 6 (2) ◽

pp. 410

Author(s):

Shriganesh D. Kamat ◽

Nitin N. Puram ◽

Prakash R. Dhumal ◽

Pushpa I. Agrawal ◽

Jaiprakash B. Ramanand ◽

...

Keyword(s):

Spinal Anaesthesia ◽

Lower Limb ◽

Low Dose ◽

Control Group ◽

Spinal Block ◽

Motor Blockade ◽

Hyperbaric Bupivacaine ◽

Sensory Blockade ◽

Group B ◽

Randomised Controlled

Background: Spinal anaesthesia remains one of the basic techniques in the arsenal of modern anaesthesiology despite the waxing and waning of its popularity over last 100 years since its introduction into clinical practice.It avoids biochemical and metabolic changes consequent to the stress of general anesthesia for surgery as well as provides near optimal conditions for surgery. In present study, we tried to study effectiveness of intrathecal 0.5% heavy bupivacaine alone with Dexmedetomidine as an adjuvant to intrathecal 0.5% heavy bupivacaine for lower limb and lower abdominal surgeries.Methods: The present study was conducted in the department of anaesthesiology from December 2011 to September 2013.This study was a prospective, randomised controlled, single blind, study conducted in 100 patients of ASA grade I and II undergoing elective surgeries under spinal anaesthesia. The patients were divided randomly into two groups, containing 50 patients in each group. Dosages of drugs selected are divided as Group B: Patients received 3 ml of 0.5% hyperbaric bupivacaine (15mg) and Group BD: Patients received 3 ml of 0.5% hyperbaric bupivacaine (15mg) plus 10 µg Dexmedetomidine. Spinal block characteristics, Mean arterial pressure, Mean pulse rate, sedation and side effects were studied during intra-operative and postoperative period.Results: It was found from present study that in Dexmedetomidine group time to reach T10 sensory blockade and complete motor blockade was earlier and a higher level of sensory blockade compared to control group achieved. Duration of sensory, motor blockade and duration of analgesia was significantly prolonged in the Dexmedetomidine group compared to the control group. Hemodynamic parameters were preserved both intra-operatively and postoperatively. However there were a small percentage of patients who developed hypotension and bradycardia which were easily managed without any untoward effect. Hence Dexmedetomidine is a better neuraxial adjuvant for providing early onset of sensory and motor blockade, prolonged sensory blockade and post operative analgesia and adequate sedation.Conclusions: Intrathecal low dose Dexmedetomidine in a dose of 10µg along with 0.5% hyperbaric bupivacaine is an addition into anaesthesiologist's armamentarium for spinal anaesthesia in patients undergoing elective lower abdominal and lower limb surgeries.

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Effect of addition of intrathecal midazolam to 0.5% hyperbaric bupivacaine to prolong the post-operative analgesia in lower abdominal surgeries

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20192240 ◽

2019 ◽

Vol 6 (3) ◽

pp. 790

Author(s):

S. K. Adil Hasan

Keyword(s):

Clinical Study ◽

Statistical Significance ◽

Mean Difference ◽

Maximum Height ◽

Motor Blockade ◽

Medical Sciences ◽

Hyperbaric Bupivacaine ◽

Sensory Blockade ◽

Midazolam Group ◽

Duration Of Surgery

Background: Bupivacaine when used alone produces analgesia for 2.5 to 3 hours, making it unsuitable in cases where the duration of surgery is longer and in cases which require further analgesia during post-operative period. Present study is intended to evaluate the effect of addition of intrathecal midazolam to bupivacaine to prolong the post-operative analgesia.Methods: Present clinical study was conducted in Kamineni Institute of Medical Sciences, Narketpally, Nalgonda District, Andhra Pradesh, India. After obtaining approval from institutional ethical committee, present clinical study was undertaken to evaluate the effects of addition of intrathecal midazolam to bupivacaine 0.5% (heavy). The study was conducted on 60 patients undergoing lower abdominal surgeries.Results: Mean onset of analgesia was 190.5 with SD 21.3 in group-C whereas in group-M, mean onset of analgesia was 185.3 with SD 26.81. Mean difference between the groups not showing statistical significance. In the present study the Maximum height of sensory blockade in control and midazolam group was T7 (T6-T8) compared to T7 (T6-T8) midazolam group. Mean duration of sensory blockade was 130.4 with SD 36.36 in group-C whereas in group-M, mean duration of sensory blockade was 191.9 with SD 36.4. Mean difference between the groups showing statistical significance. Mean duration of motor blockade was 176.3 with SD 23.7 in group-C whereas in group-M, mean duration of motor blockade was 208.1 with SD 18.21. Mean difference between the groups showing statistical significance.Conclusions: Midazolam is a useful adjuvant to bupivacaine in subarachnoid block. Intrathecal midazolam combined with intrathecal bupivacaine produces a longer and more effective anaesthesia and analgesia. It also prolongs post-operative analgesia without increasing adverse effects.

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