title: Effects of adding midazolam on the postoperative epidural analgesia with two different doses of bupivacaine.
abstract: OBJECTIVE
  To investigate the interaction of midazolam with different doses of bupivacaine, by comparing the analgesic, sedative, and amnesic effects of continuous epidural midazolam with two different doses of bupivacaine.
  
  
  METHODS
  Prospective, randomized study.
  
  
  METHODS
  Operating room and intensive care units of a university hospital.
  
  
  METHODS
  100 ASA physical status I and II postgastrectomy patients (40-70 yrs) without any complications.
  
  
  METHODS
  Patients were divided into four groups (n = 25) and administered continuous thoracic epidural infusion (40 mL/12 hr) of the drugs via a balloon infuser. The contents of the infuser (40 mL) were bupivacaine 180 mg with midazolam 20 mg (HM group), 90 mg with midazolam 20 mg (LM group), 180 mg without midazolam (HC group), or 90 mg without midazolam (LC group). As a rescue medication, 50 mg indomethacin suppository was the first choice, then IM pentazocine 15 mg.
  
  
  METHODS
  Analgesia and sedation scores, blood pressure (BP), heart rate, respiratory rate, oxygen saturation, amnesia, the number of rescue medications, and time to the first rescue medication were monitored. The area under the curves (AUCs) of analgesia and sedation scores, and BP were calculated.
  
  
  RESULTS
  In the HM group, significantly better analgesia and sedation were obtained and the number of rescue medications given was the lowest of the four groups. The time to the first rescue medication was longest in the HM group, followed by the LM group, then the HC, and, finally, LC groups. The numbers of the patients with amnesia were greater in the HM and LM groups than the HC and LC groups. Blood pressure decreased significantly in the HM group but no treatment was necessary. The AUCs of analgesia and sedation scores, and BP were lowest in the HM group.
  
  
  CONCLUSIONS
  Adding midazolam increased not only analgesic but also sedative effect with increasing dose of bupivacaine in a postoperative continuous epidural administration.
authors.affiliation: Surgical Center, The Institute of Medical Science, The University of Tokyo, Japan. nishiyam@ims.u-tokyo.ac.jp
authors.forename: Tomoki
authors.initials: T
authors.lastname: Nishiyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsukawa
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hanaoka
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage*; D016292:Procedural Sedation; D005260:Female; D018757:GABA Modulators / Q000008:administration & dosage; D005743:Gastrectomy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008568:Memory; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D000759:Adjuvants, Anesthesia; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D018757:GABA Modulators; D006993:Hypnotics and Sedatives; D008874:Midazolam; D002045:Bupivacaine