- Email: [email protected]
The analgesic and sedative effects of intrathecal midazolam in perianal surgery
Posters
•
Central Nerve Blocks V
31
Central Nerve Blocks V 172. The analgesic and sedative effects of intrathecal midazolam in perianal surgery Ozgurel O Department of Anaesthesiology, Akdeniz University, Antalya, Turkey Background and goal of study: The administration of midazolam by centroneuraxis route has been shown to produce segmental antinociception. Our purpose was to evaluate the analgesic and sedative effects of intrathecal midazolam when added to spinal bupivacaine in patients undergoing perianal surgery under spinal anaesthesia. Material and methods: The patients were randomly allocated into two groups of 15: Group I received 2 ml of 0.5% hyperbaric bupivacaine ⫹ 1 ml of 0.9% saline in 3 ml volume intrathecally and midazolam 2 mg in 2 ml administered via intravenous route; Group II received 2 ml of 0.5% hyperbaric bupivacaine ⫹ preservative free midazolam 2 mg in 3 ml intrathecally and 2 ml of 0.9% saline intravenously. Times from spinal injection to maximum motor and sensorial blocks, resolution of the blocks, patient’s degree of sedation, and the time of the first analgesic requirements were recorded. Results and discussion: There were no significant differences at the onset and the full recovery times of either motor block or sensorial block between the groups (P ⫽ 0.734, P ⫽ 0.667, and P ⫽ 0.379, P ⫽ 0.676, respectively). Postoperative Visual Analogue Pain scores were not significantly different during the postoperative 24 hours (P ⫽ 0.089). In Group II, the average time until the first dose of additional analgesic requirement was significantly longer than Group I (211.93 ⫾ 48.92 min vs. 170.66 ⫾ 38.83 min, respectively; P ⫽ 0.016). Patient’s degree of sedation with the Goldberg sedation scale were 0/1/2/3: 0/2/11/2 respectively in the Group I, and 0/1/2/3: 9/6/0/0 respectively in the Group II (P ⬍ 0.001). Conclusion: Surprisingly, we observed the first degree sedation at 6 patients administered intrathecal midazolam. We concluded that the use of intrathecal midazolam in perianal surgery has considerable analgesic and sedative effects.
References 1. Int J Clin Pharmacol. Ther 1999;37:519-523. 2. J Clin Anesth. 2002;14:92-97.
179. Mortality analysis in fast track rehabilitation with epidural analgesia in hip fracture patients Foss NB, Kristensen BB, Krasheninnikoff M, Jensen PS, Kristensen MT, Kehlet H Departments of Anesthesiology, Orthopaedic Surgery, Physiotherapy, and Surgical Gastroenterology, Hvidovre University Hospital, Copenhagen, Denmark Background: Patients with hip fractures have a high perioperative mortality and morbidity, with a 30-day mortality in excess of 10%.1 Regional anaesthesia with neuraxial blockade has been shown to decrease postoperative mortality and morbidity in lower body procedures,2 but its effect remains to be proven in the hip fracture population.3 Since hip fracture patients are frail and have several co-morbidities, the advantageous physiological effect of regional anaesthesia may only have clinical implications in a restricted number of patients. We therefore analysed the causes of death in a consecutive patient series with hip fractures. Material and methods: One hundred fifty patients with primary hip fracture received a multimodal fast-track regimen4 epidural anaesthesia, postoperative epidural analgesia, early surgery, optimised fluid and transfusion therapy as well as intensive. An analysis of causality was made in all in-hospital deaths, including patients discharged to end-of-life care. Death was classified as unavoidable if it was due to prefracture intractable disease with predictable short life expectancy or a patient declining appropriate postoperative care. Results: In hospital mortality was 10.6% with 16 fatalities, mean age 81.2 (74-95) years. 30-day mortality was 8.6%. Patients died on average 14.6 (3-46) days postoperatively. Seven (44%) deaths were classified as unavoidable: 4 patients had disseminated malignant disease and 3 patients refused relevant postoperative treatment. Potentially avoidable deaths were due to sepsis in 1, duodenal ulcer in 2, surgical complications in 2 and cardiovascular complications in 4 patients. Conclusion: Due to the high co-morbidity of hip fracture patients, about 38% of the fatalities are essentially unavoidable regardless of the perioperative regimen, including regional anaesthesia. Future studies in the potential benefits of regional analgesia and anaesthesia for hip fracture patients should focus on other relevant outcome.
References 1. Goldacre MJ, Roberts SE, Yeates D. Mortality after admission to hospital with fractured neck of femur: database study. BMJ. 2002;325:868-869. 2. Rodgers A, Walker N, Schug S, et al. Reduction aof postoperative mortality and morbidity with epidural and spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321:1-12. 3. Parker MJ, Handol HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2001;(4):CD000521. 4. Rasmussen S, Kristensen BB, Foldager S, et al. Accelerated recovery programme after hip fracture. Ugeskr Laeger. 2002;165:29-33.
•
Central Nerve Blocks V
31
Central Nerve Blocks V 172. The analgesic and sedative effects of intrathecal midazolam in perianal surgery Ozgurel O Department of Anaesthesiology, Akdeniz University, Antalya, Turkey Background and goal of study: The administration of midazolam by centroneuraxis route has been shown to produce segmental antinociception. Our purpose was to evaluate the analgesic and sedative effects of intrathecal midazolam when added to spinal bupivacaine in patients undergoing perianal surgery under spinal anaesthesia. Material and methods: The patients were randomly allocated into two groups of 15: Group I received 2 ml of 0.5% hyperbaric bupivacaine ⫹ 1 ml of 0.9% saline in 3 ml volume intrathecally and midazolam 2 mg in 2 ml administered via intravenous route; Group II received 2 ml of 0.5% hyperbaric bupivacaine ⫹ preservative free midazolam 2 mg in 3 ml intrathecally and 2 ml of 0.9% saline intravenously. Times from spinal injection to maximum motor and sensorial blocks, resolution of the blocks, patient’s degree of sedation, and the time of the first analgesic requirements were recorded. Results and discussion: There were no significant differences at the onset and the full recovery times of either motor block or sensorial block between the groups (P ⫽ 0.734, P ⫽ 0.667, and P ⫽ 0.379, P ⫽ 0.676, respectively). Postoperative Visual Analogue Pain scores were not significantly different during the postoperative 24 hours (P ⫽ 0.089). In Group II, the average time until the first dose of additional analgesic requirement was significantly longer than Group I (211.93 ⫾ 48.92 min vs. 170.66 ⫾ 38.83 min, respectively; P ⫽ 0.016). Patient’s degree of sedation with the Goldberg sedation scale were 0/1/2/3: 0/2/11/2 respectively in the Group I, and 0/1/2/3: 9/6/0/0 respectively in the Group II (P ⬍ 0.001). Conclusion: Surprisingly, we observed the first degree sedation at 6 patients administered intrathecal midazolam. We concluded that the use of intrathecal midazolam in perianal surgery has considerable analgesic and sedative effects.
References 1. Int J Clin Pharmacol. Ther 1999;37:519-523. 2. J Clin Anesth. 2002;14:92-97.
179. Mortality analysis in fast track rehabilitation with epidural analgesia in hip fracture patients Foss NB, Kristensen BB, Krasheninnikoff M, Jensen PS, Kristensen MT, Kehlet H Departments of Anesthesiology, Orthopaedic Surgery, Physiotherapy, and Surgical Gastroenterology, Hvidovre University Hospital, Copenhagen, Denmark Background: Patients with hip fractures have a high perioperative mortality and morbidity, with a 30-day mortality in excess of 10%.1 Regional anaesthesia with neuraxial blockade has been shown to decrease postoperative mortality and morbidity in lower body procedures,2 but its effect remains to be proven in the hip fracture population.3 Since hip fracture patients are frail and have several co-morbidities, the advantageous physiological effect of regional anaesthesia may only have clinical implications in a restricted number of patients. We therefore analysed the causes of death in a consecutive patient series with hip fractures. Material and methods: One hundred fifty patients with primary hip fracture received a multimodal fast-track regimen4 epidural anaesthesia, postoperative epidural analgesia, early surgery, optimised fluid and transfusion therapy as well as intensive. An analysis of causality was made in all in-hospital deaths, including patients discharged to end-of-life care. Death was classified as unavoidable if it was due to prefracture intractable disease with predictable short life expectancy or a patient declining appropriate postoperative care. Results: In hospital mortality was 10.6% with 16 fatalities, mean age 81.2 (74-95) years. 30-day mortality was 8.6%. Patients died on average 14.6 (3-46) days postoperatively. Seven (44%) deaths were classified as unavoidable: 4 patients had disseminated malignant disease and 3 patients refused relevant postoperative treatment. Potentially avoidable deaths were due to sepsis in 1, duodenal ulcer in 2, surgical complications in 2 and cardiovascular complications in 4 patients. Conclusion: Due to the high co-morbidity of hip fracture patients, about 38% of the fatalities are essentially unavoidable regardless of the perioperative regimen, including regional anaesthesia. Future studies in the potential benefits of regional analgesia and anaesthesia for hip fracture patients should focus on other relevant outcome.
References 1. Goldacre MJ, Roberts SE, Yeates D. Mortality after admission to hospital with fractured neck of femur: database study. BMJ. 2002;325:868-869. 2. Rodgers A, Walker N, Schug S, et al. Reduction aof postoperative mortality and morbidity with epidural and spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321:1-12. 3. Parker MJ, Handol HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2001;(4):CD000521. 4. Rasmussen S, Kristensen BB, Foldager S, et al. Accelerated recovery programme after hip fracture. Ugeskr Laeger. 2002;165:29-33.