Midazolam Case Study

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Background: Adjuncts to local anaesthetics for brachial plexus block may enhance the quality and duration of analgesia. Midazolam, a water-soluble benzodiazepine, is known to produce antinociception and enhance the effect of local anaesthetics when given epidurally or intrathecally. Aim: Study was to assess the effect of Midazolam added to brachial plexus block by supraclavicular approach. Materials and Methods: A prospective, randomized, single blinded study was conducted on 100 ASA Grade I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly divided into two groups. Patients in Group B (n = 50) Bupivacaine and Group BM (n = 50) Bupivacaine with Midazolam. The onset time…show more content…
They achieve near-ideal operating conditions by producing complete muscular relaxation, maintaining stable intra-operative haemodynamics and the associated sympathetic block. The sympathetic block decreases postoperative pain, vasospasm and edema. Of various local anaesthetics, Bupivacaine is used most frequently, as it has a long duration of action varying from 3 to 8 hours1-4. However there are many limiting factors like delayed onset, patchy or incomplete analgesia, sometimes short duration etc. Various drugs like Neostigmine, Opioids, Hyaluronidase, and Clonidine etc.1-4 have been added to local anaesthetics in order to modify the block in terms of quick onset, good quality, prolonged duration and post-operative analgesia. But these are not without adverse systemic effects or of doubtful efficacy. Midazolam, a water-soluble benzodiazepine is known to produce antinociception and to enhance the effect of local anaesthetic when given epidurally or intrathecally. Midazolam produces this effect by its action on Gamma Amino Butyric Acid-A (GABA-A) receptors. GABA receptors have also been found in peripheral nerves. So the present study is being undertaken in a randomized single blinded manner to evaluate the onset time and analgesic efficacy of Midazolam- Bupivacaine combination compared to plain Bupivacaine (0.375%) for brachial plexus block by supraclavicular…show more content…
Exclusion criteria is that patient refusal, known cause of hypersensitive reaction to midazolam or bupivacaine, patients with medical complications like severe hypovolemia, shock, septicaemia etc., patients with abnormal coagulation profile, local infection at the site of proposed puncture of supraclavicular block.
Investigations required are Haemoglobin (Hb%), Total Leucocyte Count (TLC), Differential Leucocyte Count(DLC), Bleeding Time (BT), Clotting Time(CT), Random Blood Sugar(RBS), Blood urea and Serum Creatinine ,ECG ,HIV, HBs Ag. Written informed consent, intravenous access to a 20 guage IV cannula on the contralateral upper limb under aseptic techniques.
Procedure: A prospective, randomized, single blinded study was undertaken. 100 patients posted for upper limb surgeries under supraclavicular block were assigned to 2 groups, each containing 50 patients.
Control group – Group-B: received 30 ml Bupivacaine

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