title: Preemptive analgesia with midazolam and diclofenac for hernia repair pain.
abstract: OBJECTIVE
  The aim of this study was to compare the preemptive effects of systemic midazolam and diclofenac on postoperative analgesia when used before surgical incision.
  
  
  METHODS
  Ninety patients, aged 35-65 years, scheduled for hernia repair surgery were included in the study. Forty five patients in the midazolam group (group M + D) received 0.05 mg/kg midazolam and 1.5 mg/kg diclofenac, 15 min before surgical incision; 45 patients in the diclofenac group (group D) received diclofenac without midazolam, 15 min before surgical incision. Postoperative pain (Verbal Rating Scale-6) score and first analgesic requirement were noted. Sedation levels were evaluated with Observer's Assessment of Alertness/Sedation (OAA/S) score. Adverse effects during and after the operation were also recorded.
  
  
  RESULTS
  Group M + D had a significantly lower proportion of patients who exhibited postoperative pain than group D (11.1% vs. 37.7%, respectively; P < 0.05). The VRS-6 score in group M + D was 1.4 (range 0-4), whereas the corresponding score in group D was 2.4 (range 1-6). Mean (OAA/S) score in group M + D was lower than in the group D (1.5 ± 0.3 vs. 3.3 ± 0.4, respectively; P < 0.05). Duration of sedation in group M + D was significantly longer than the corresponding mean for group D (22.5 ± 6.4 vs. 12.1 ± 3.3 min, respectively; P < 0.01). The first postoperative analgesic request after surgery was 120 min in group M + D and 60 min in group D (P < 0.05).
  
  
  CONCLUSIONS
  Midazolam enhances the postoperative analgesic effects of diclofenac when used before the onset of noxious stimuli.
authors.affiliation: Department of Anesthesiology and Reanimation, University Clinical Centre of Kosovo, Prishtina, Kosovo. antigona.hasani@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Hasani
authors.forename: H
authors.initials: H
authors.lastname: Maloku
authors.forename: F
authors.initials: F
authors.lastname: Sallahu
authors.forename: V
authors.initials: V
authors.lastname: Gashi
authors.forename: S U
authors.initials: SU
authors.lastname: Ozgen
mesh_terms: D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004008:Diclofenac / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007022:Hypotension / Q000209:etiology; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D011292:Premedication; D013997:Time Factors
chemical_list: D016861:Cyclooxygenase Inhibitors; D006993:Hypnotics and Sedatives; D004008:Diclofenac; D008874:Midazolam