title: Midazolam with bupivacaine for improving analgesia quality in brachial plexus block for upper limb surgeries.
abstract: OBJECTIVE
  To compare the onset, duration and postoperative pain scores of supraclavicular block with bupivacaine alone and bupivacaine-midazolam combination.
  
  
  METHODS
  Randomized controlled clinical trial.
  
  
  METHODS
  The Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from April 2005 to June 2007.
  
  
  METHODS
  A randomized controlled clinical trial was conducted on 50 ASA-I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly allocated into two groups of 25 each. Patients in group A were administered 30 ml of 0.5% bupivacaine and those in group B were given 30 ml of 0.5% bupivacaine with midazolam 50 microg x kg-1. Hemodynamic variables (heart rate, noninvasive blood pressure, oxygen saturation), pain scores, rescue analgesic requirements and sedation score were recorded for 24 hours postoperatively, and compared using ANOVA with significance at p <0.05.
  
  
  RESULTS
  The onset and duration of sensory and motor block was significantly faster and longer in group B compared to group A (p < 0.001). Pain scores were significantly lower in group B for 24 hours postoperatively (p < 0.001). Demand for rescue analgesic were significantly less in group B. Hemodynamics and sedation scores did not differ between the groups in the studied period.
  
  
  CONCLUSIONS
  Bupivacaine (0.5%) in combination with Midazolam (50 microg x kg-1) quickened the onset as well as prolonged the duration of sensory and motor blockade of the brachial plexus for upper limb surgery. It improved postoperative analgesia without producing any adverse events compared to plain bupivacaine (0.5%) in equal volume.
authors.affiliation: Department of Anaesthesiology/Ophthalmology/Orthopaedic, PGMI, Hayatabad Medical Complex, Peshawar. nasreenlaiq@yahoo.com
authors.forename: Nasreen
authors.initials: N
authors.lastname: Laiq
authors.forename: Mohammad Naeem
authors.initials: MN
authors.lastname: Khan
authors.forename: Mohammad
authors.initials: M
authors.lastname: Arif
authors.forename: Shahid
authors.initials: S
authors.lastname: Khan
mesh_terms: D000759:Adjuvants, Anesthesia / Q000493:pharmacokinetics / Q000627:therapeutic use; D000328:Adult; D000704:Analysis of Variance; D018686:Anesthetics, Intravenous / Q000493:pharmacokinetics / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000493:pharmacokinetics / Q000627:therapeutic use; D001917:Brachial Plexus / Q000187:drug effects*; D002045:Bupivacaine / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008874:Midazolam / Q000493:pharmacokinetics / Q000627:therapeutic use*; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011787:Quality of Health Care; D013997:Time Factors; D034941:Upper Extremity / Q000294:innervation*; D005680:gamma-Aminobutyric Acid / Q000187:drug effects
chemical_list: D000759:Adjuvants, Anesthesia; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D005680:gamma-Aminobutyric Acid; D008874:Midazolam; D002045:Bupivacaine