Title of article :
Intravenous Midazolam as More Effective Than Propofol for Preventing Pruritus After Intrathecal Sufentanil in Surgical Patients: A Randomized Blinded Trial
Author/Authors :
Makarem, Jalil Department of Anesthesiology & Critical Care - Imam Khomeini Hospital Complex - Tehran University of Medical Sciences, Tehran , Mireskandari, Mohammad Department of Anesthesiology & Critical Care - Imam Khomeini Hospital Complex - Tehran University of Medical Sciences, Tehran , Jafarzadeh, Afshin Department of Anesthesiology & Critical Care - Imam Khomeini Hospital Complex - Tehran University of Medical Sciences, Tehran , Rahbar Nikoukar, Laya Imam Khomeini Hospital Complex - Tehran University of Medical Sciences, Tehran , Aghaii, Sara Imam Khomeini Hospital Complex - Tehran University of Medical Sciences, Tehran
Abstract :
Background: Pruritus is a troublesome side effect of intrathecal opioids. Midazolam can reinforce GABA-mediated inhibition of the medullary dorsal horn neurons, and thus theoretically has potential to suppress opioid-induced pruritus.
Objectives: This prospective double-blinded randomized trial aimed at comparing the effects of propofol, midazolam, and a combination of the two on the prevention of pruritus induced by intrathecal sufentanil.
Methods: Eighty-four patients undergoing spinal anesthesia with 3 mL hyperbaric bupivacaine 0.5% and 5 g sufentanil (1 mL) were randomly allocated to one of the three study groups: Group 1, who were administered 20 mg intravenous (IV) propofol bolus, then 50 g/kg/min IV infusion; Group 2, who were administered 0.03 mg/kg IV midazolam bolus, then 0.02 mg/kg/h IV infusion; and Group 3, who were administered 10 mg IV propofol and 0.015 mg/kg IV midazolam bolus, then 25 g/kg/min propofol and 0.01 mg/kg/h midazolam IV infusion. The incidence rates and severity of pruritus were assessed intraoperatively and postoperatively for 24 hours.
Results: The Ramsay Sedation Score was highest for the propofol group throughout the duration of the anesthetic process. Overall, 17 patients in the propofol group (60.7%), eight patients in the midazolam group (28.6%), and nine patients in the propofolmidazolam group (32.1%) developed pruritus (P = 0.027). Intraoperative pruritus was observed in seven patients in the propofol group (25%), two patients in the midazolam group (7.1%), and five patients in the midazolam-propofol group (17.9%) (P = 0.196). Postoperative pruritus developed in 12 patients in the propofol group (42.9%), six patients in the midazolam group (21.4%), and four patients in the midazolam-propofol group (14.3%) (P = 0.041). There was no significant difference between the groups with respect to the severity of pruritus (P > 0.05).
Conclusions: This study showed that in comparison with propofol, the administration of 0.03 mg/kg IV midazolam bolus followed by 0.02 mg/kg/h could be more effective in the prevention of intrathecal sufentanil-induced pruritus without increasing sedation
and other side effects.
Keywords :
Midazolam , Propofol , Sufentanil , Pruritus , Spinal Anesthesia
Journal title :
Astroparticle Physics