Effects of Intrathecal Bupivacaine with Adjuvants Midazolam versus Magnesium Sulphate in Tibia Fibula Surgeries: A Randomised Clinical Study
Introduction: Intrathecal adjuvants like magnesium sulphate, midazolam and opioids are increasingly used with local anaesthetic for spinal anaesthesia to intensify subarachnoid block and improve haemodynamic stability. Midazolam, a benzodiazepine, is mainly used for anxiolysis, amnesia and sedation....
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JCDR Research and Publications Private Limited
2025-01-01
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| author | Tejash H Sharma Jagrati Jain Aanal Sha Dushyant Chavda Dinesh K Chauhan |
| author_facet | Tejash H Sharma Jagrati Jain Aanal Sha Dushyant Chavda Dinesh K Chauhan |
| author_sort | Tejash H Sharma |
| collection | DOAJ |
| description | Introduction: Intrathecal adjuvants like magnesium sulphate, midazolam and opioids are increasingly used with local anaesthetic for spinal anaesthesia to intensify subarachnoid block and improve haemodynamic stability. Midazolam, a benzodiazepine, is mainly used for anxiolysis, amnesia and sedation. It also exhibits a muscle relaxant effect via its action on the glycine receptors in the spinal cord. Magnesium sulphate is a pharmacological agent used in a variety of clinical conditions. It potentiates opioid nociception and prolongs the duration of anaesthesia. The analgesic properties of magnesium sulphate are primarily related to regulating calcium influx into cells and antagonism of N-methyl D-aspartate (NMDA) receptors.
Aim: To observe the efficacy of intrathecal 2.5 mg midazolam and 50 mg magnesium sulphate as adjuvants to 0.5% hyperbaric bupivacaine in tibia-fibula surgeries and haemodynamic stability in both groups.
Materials and Methods: The present double-blind, prospective randomised clinical study was conducted in the Department of Anaesthesiology, Dhiraj Hospital, Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat, India, from February 2021 to December 2022. Study included 64 patients of either gender, classified as American Society of Anaesthesiologists (ASA) grade I/II, undergoing tibia-fibula surgeries. Patients were divided into two groups: Group BM (Midazolam) received 0.5% hyperbaric bupivacaine 3.2 mL+2.5 mg midazolam (0.5 mL), totaling 3.7 mL and group BMS (Magnesium sulphate) received 0.5% hyperbaric bupivacaine 3.2 mL+50 mg magnesium sulphate (0.5 mL), totaling 3.7 mL. The primary objective was to observe Heart Rate (HR), Blood Pressure (BP), Oxygen Saturation (SpO2) and Respiratory Rate (RR). Secondary objectives were to observe the time to onset of sensory and motor blockade, duration of sensory and motor blockade, time of two-segment regression, duration of analgesia, sedative effect (intra and postoperative), and any side effects or complications. Statistical analysis was performed using International Business Machines (IBM) Statisical Package for the Social Sciences (SPSS) statistics for Windows software.
Results: The mean Standard Deviation (SD) age in group BM was 37.63±11.50 years and in group BMS was 40.81±11.93 years. The onset and duration of sensory and motor blockade were better in group BM than in group BMS (p-value <0.05). In terms of complications, bradycardia was noted in a few cases in group BM after giving spinal anaesthesia. In group BM at two minutes, the mean HR was 76.12±10.71 beats per minute, which was significantly lower than in group BMS 87.56±7.76 beats per minute (p-value <0.05). Hypotension was noted after spinal anaesthesia in group BM. At two minutes, Systolic Blood Pressure (SBP) was 94.81±19.69 mmHg in group BM and 123.0±8.34 mmHg in group BMS (p-value <0.05); at 10 minutes, SBP was 106.0±14.91 mmHg in group BM and 117.3±12.20 mmHg in group BMS (p-value <0.05).
Conclusion: Intrathecal magnesium sulphate (50 mg) provided better haemodynamic stability compared to intrathecal midazolam (2.5 mg) in patients undergoing tibia-fibula surgeries. |
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| institution | Kabale University |
| issn | 2249-782X 0973-709X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | JCDR Research and Publications Private Limited |
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| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj-art-7c9b8d86dffe4114b49329117b60d5982025-01-27T11:53:24ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2025-01-011901505510.7860/JCDR/2025/76306.20540Effects of Intrathecal Bupivacaine with Adjuvants Midazolam versus Magnesium Sulphate in Tibia Fibula Surgeries: A Randomised Clinical StudyTejash H Sharma0https://orcid.org/0000-0001-6656-0834Jagrati Jain1https://orcid.org/0009-0006-0611-940XAanal Sha2Dushyant Chavda3https://orcid.org/0009-0005-6649-5856Dinesh K Chauhan4Professor, Department of Anaesthesiology, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth (Deemed to be University), Piparia, Vadodara, Gujarat, India.3rd Year Postgraduate Resident, Department of Anaesthesiology, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth (Deemed to be University), Piparia, Vadodara, Gujarat, India.Senior Resident, Department of Anaesthesiology, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth (Deemed to be University), Piparia, Vadodara, Gujarat, India.Assistant Professor, Department of Anaesthesiology, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth (Deemed to be University), Piparia, Vadodara, Gujarat, India. Professor, Department of Anaesthesiology, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth (Deemed to be University), Piparia, Vadodara, Gujarat, India.Introduction: Intrathecal adjuvants like magnesium sulphate, midazolam and opioids are increasingly used with local anaesthetic for spinal anaesthesia to intensify subarachnoid block and improve haemodynamic stability. Midazolam, a benzodiazepine, is mainly used for anxiolysis, amnesia and sedation. It also exhibits a muscle relaxant effect via its action on the glycine receptors in the spinal cord. Magnesium sulphate is a pharmacological agent used in a variety of clinical conditions. It potentiates opioid nociception and prolongs the duration of anaesthesia. The analgesic properties of magnesium sulphate are primarily related to regulating calcium influx into cells and antagonism of N-methyl D-aspartate (NMDA) receptors. Aim: To observe the efficacy of intrathecal 2.5 mg midazolam and 50 mg magnesium sulphate as adjuvants to 0.5% hyperbaric bupivacaine in tibia-fibula surgeries and haemodynamic stability in both groups. Materials and Methods: The present double-blind, prospective randomised clinical study was conducted in the Department of Anaesthesiology, Dhiraj Hospital, Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat, India, from February 2021 to December 2022. Study included 64 patients of either gender, classified as American Society of Anaesthesiologists (ASA) grade I/II, undergoing tibia-fibula surgeries. Patients were divided into two groups: Group BM (Midazolam) received 0.5% hyperbaric bupivacaine 3.2 mL+2.5 mg midazolam (0.5 mL), totaling 3.7 mL and group BMS (Magnesium sulphate) received 0.5% hyperbaric bupivacaine 3.2 mL+50 mg magnesium sulphate (0.5 mL), totaling 3.7 mL. The primary objective was to observe Heart Rate (HR), Blood Pressure (BP), Oxygen Saturation (SpO2) and Respiratory Rate (RR). Secondary objectives were to observe the time to onset of sensory and motor blockade, duration of sensory and motor blockade, time of two-segment regression, duration of analgesia, sedative effect (intra and postoperative), and any side effects or complications. Statistical analysis was performed using International Business Machines (IBM) Statisical Package for the Social Sciences (SPSS) statistics for Windows software. Results: The mean Standard Deviation (SD) age in group BM was 37.63±11.50 years and in group BMS was 40.81±11.93 years. The onset and duration of sensory and motor blockade were better in group BM than in group BMS (p-value <0.05). In terms of complications, bradycardia was noted in a few cases in group BM after giving spinal anaesthesia. In group BM at two minutes, the mean HR was 76.12±10.71 beats per minute, which was significantly lower than in group BMS 87.56±7.76 beats per minute (p-value <0.05). Hypotension was noted after spinal anaesthesia in group BM. At two minutes, Systolic Blood Pressure (SBP) was 94.81±19.69 mmHg in group BM and 123.0±8.34 mmHg in group BMS (p-value <0.05); at 10 minutes, SBP was 106.0±14.91 mmHg in group BM and 117.3±12.20 mmHg in group BMS (p-value <0.05). Conclusion: Intrathecal magnesium sulphate (50 mg) provided better haemodynamic stability compared to intrathecal midazolam (2.5 mg) in patients undergoing tibia-fibula surgeries.https://www.jcdr.net/articles/PDF/20540/76306_CE[Ra1]__F(SHU)_QC(SD_SHU)_PF1(JY_IS)_redo(SL)_PFA(IS)_PN(IS).pdfbenzodiazepinehaemodynamic stabilityorthopaedic surgeriesspinal anaesthesia |
| spellingShingle | Tejash H Sharma Jagrati Jain Aanal Sha Dushyant Chavda Dinesh K Chauhan Effects of Intrathecal Bupivacaine with Adjuvants Midazolam versus Magnesium Sulphate in Tibia Fibula Surgeries: A Randomised Clinical Study Journal of Clinical and Diagnostic Research benzodiazepine haemodynamic stability orthopaedic surgeries spinal anaesthesia |
| title | Effects of Intrathecal Bupivacaine with Adjuvants Midazolam versus Magnesium Sulphate in Tibia Fibula Surgeries: A Randomised Clinical Study |
| title_full | Effects of Intrathecal Bupivacaine with Adjuvants Midazolam versus Magnesium Sulphate in Tibia Fibula Surgeries: A Randomised Clinical Study |
| title_fullStr | Effects of Intrathecal Bupivacaine with Adjuvants Midazolam versus Magnesium Sulphate in Tibia Fibula Surgeries: A Randomised Clinical Study |
| title_full_unstemmed | Effects of Intrathecal Bupivacaine with Adjuvants Midazolam versus Magnesium Sulphate in Tibia Fibula Surgeries: A Randomised Clinical Study |
| title_short | Effects of Intrathecal Bupivacaine with Adjuvants Midazolam versus Magnesium Sulphate in Tibia Fibula Surgeries: A Randomised Clinical Study |
| title_sort | effects of intrathecal bupivacaine with adjuvants midazolam versus magnesium sulphate in tibia fibula surgeries a randomised clinical study |
| topic | benzodiazepine haemodynamic stability orthopaedic surgeries spinal anaesthesia |
| url | https://www.jcdr.net/articles/PDF/20540/76306_CE[Ra1]__F(SHU)_QC(SD_SHU)_PF1(JY_IS)_redo(SL)_PFA(IS)_PN(IS).pdf |
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