title: Brachial plexus block with midazolam and bupivacaine improves analgesia.
abstract: OBJECTIVE
  Adjuncts to local anesthetics 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 anesthetics when given epidurally or intrathecally. The purpose of this study was to assess the effect of midazolam added to brachial plexus anesthesia.
  
  
  METHODS
  A prospective, randomized, double blind study was conducted on 40 ASA 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 = 20) were administered 30 mL of 0.5% bupivacaine and Group BM (n = 20) were given 30 mL of 0.5% bupivacaine with midazolam 50 microg x kg(-1). Hemodynamic variables (i.e., heart rate, noninvasive blood pressure), pain scores and rescue analgesic requirements were recorded for 24 hr postoperatively.
  
  
  RESULTS
  The onset of sensory and motor block was significantly faster in Group BM compared to Group B (P < 0.05). Pain scores were significantly higher in Group B compared to Group BM from two hours to 24 hr postoperatively (P < 0.05). Rescue analgesic requirements were significantly less in Group BM compared to Group B (P < 0.05). Hemodynamics and sedation scores did not differ between groups in the post-operative period.
  
  
  CONCLUSIONS
  Midazolam (50 microg x kg(-1)) in combination with 30 mL of bupivacaine (0.5%) hastened onset of sensory and motor block, and improved postoperative analgesia when used in brachial plexus block, without producing any adverse events.
authors.affiliation: Department of Anesthesia and Intensive Care unit, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India.
authors.forename: Koj
authors.initials: K
authors.lastname: Jarbo
authors.forename: Yatindra Kumar
authors.initials: YK
authors.lastname: Batra
authors.forename: Nidhi Bidyut
authors.initials: NB
authors.lastname: Panda
mesh_terms: D000328:Adult; D000698:Analgesia; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D001917:Brachial Plexus; D002045:Bupivacaine; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008874:Midazolam; D009046:Motor Neurons / Q000187:drug effects; D009407:Nerve Block; D009475:Neurons, Afferent / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy; D011446:Prospective Studies
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008874:Midazolam; D002045:Bupivacaine