International Journal of Health & Allied Sciences • Vol. 1 • Issue 4 • Oct-Dec 2012 231 Original Article ABSTRACT Context: Post‑operative analgesia forms an essential ingredient of perioperative care. Various adjuvants which include opioids and non‑opioids have been used to prolong the post‑operative analgesia of intrathecal bupivacaine. Aim: The study was conducted to study the effect of intrathecal midazolam in prolonging post‑operative analgesia when used as an adjunct with bupivacaine. Settings and Design: The present study was a randomized control design conducted at Karnataka Institute of Medical Sciences, Hubli, Karnataka, India. Materials and Methods: A prospective randomized double blind placebo controlled study was undertaken to evaluate the eficacy of intrathecal midazolam as an adjunct intrathecal bupivacaine for post‑operative analgesia on 150 adult patients of ASA grade I/II scheduled to undergo elective lower abdomen, lower limb, and urological surgeries. Patients in group A (n = 75) received 3 ml of intrathecal heavy bupivacaine with 0.2 ml of saline. In group B, patients received 3 ml of intrathecal heavy bupivacaine with 0.2 ml of preservative free 1 mg of midazolam. Statistical Analysis: Mean, Standard Deviation (SD), Z test, Chi‑square test were done. Data was analyzed using Pc (XT) with minitab software version 13. Results: There was no signiicant difference observed in both the groups with respect to onset of sensory block, time taken to achieve maximum sensory block, or level of sensory block. The duration of sensory block was signiicantly longer in group B than group A (266.36 ± 22.56 min vs 187.8 ± 22.92 min). The duration of effective analgesia was prolonged in midazolam group than in the control group (232.75 ± 21.44 min vs 133.83 ± 16.23 min) with a P value <.0001. Conclusion: The duration of effective analgesia when midazolam is added to intrathecal bupivacaine is significantly prolonged thereby proving that midazolam is a useful adjunct to intrathecal bupivacaine for post‑operative analgesia. Key words: Adjuvant, bupivacaine, intrathecal, midazolam, post‑operative analgesia The role of intrathecal midazolam as an adjunct to bupivacaine in providing post‑operative pain relief Malavika Kulkarni, Madhuri Kurdi 1 , Savithri Itagimath 2 , DA Sujatha, MK Muralidhar 3 Departments of Anesthesia, 3 Comunity Medicine, Kasturba Medical College, Manipal, 1 Department of Anesthesia, 2 KIMS, Hubli, Karnataka, India Access this article online Quick Response Code: Website: www.ijhas.in DOI: 10.4103/2278-344X.107852 Address for correspondence: Dr. Malavika, Department of Anesthesia, Kasturba Medical College, Manipal University, Manipal, Karnataka, India. E‑mail: malavika.muralidhar@gmail.com INTRODUCTION Post‑operative analgesia is an important challenge in peri‑operative care. Pain results in physiological and psychological responses in the patient, the majority of which are detrimental to post‑operative outcome. [1] Inadequate relief of post‑operative pain can prolong recovery, increase the duration of stay in hospital, and increase in the health care cost. [2] It is therefore the responsibility of the modern anesthesiologist as a perioperative physician to ensure patient comfort throughout the pre‑operative, intra‑operative, and post‑operative period. [1] Among the various methods of providing post‑operative analgesia, the benefits of intrathecal opioids and non‑opioids as adjuncts in spinal anesthesia are well documented. The addition of intrathecal opioids is however associated with dose‑related adverse effects such as respiratory depression, nausea, vomiting, urinary retention, pruritus, and sedation. [3] Therefore, the use of non‑opioids such as ketamine, clonidine, neostigmine, magnesium sulfate, midazolam have become popular adjuncts for post‑operative analgesia. Several investigations have shown that intrathecal or epidural administration of midazolam produces a dose‑dependent modulation of spinal nociceptive processing in animals and humans and is not associated with neurotoxicity, respiratory depression, or sedation. [3] A method of post‑operative analgesia, which requires minimum technical intervention [Downloaded free from http://www.ijhas.in on Monday, August 17, 2015, IP: 180.215.54.8]