Comparative study of postoperative analgesia and sedation after upper abdominal surgery with thoracic epidural administration of bupivacaine with/without midazolam.

Currently continuous epidural administration of local anaesthetics with opioids is widely used for postoperative analgesia. To avoid the side-effects of opioids a drug that can replace opioids is most welcome. Midazolam not only has no side-effects but also has the advantages of sedation and amnesia. In a prospective randomised clinical study ASA class 1 or 2 patients undergoing upper abdominal surgeries were studied to compare the analgesic and sedative effect of continuous thoracic epidural infusion of bupivacaine versus continuous thoracic epidural administration of bupivacaine with midazolam postoperatively. They were divided into 2 groups. Via thoracic epidural route patients in group A (n = 24) were given 60 ml of 0.25% bupivacaine while those in group B (n = 25) were given 58 ml of 0.25% bupivacaine + midazolam 2 ml (10 mg). Each patient was infused using a syringe pump at the rate of 5 ml/hour. Variables studied postoperatively were pulse, BP, RR, SpO2, analgesia score and sedation score. Statistically significant differences in pulse, BP, RR and SpO2 were not seen. Better sedation, analgesia scores and amnesia were noted in patients belonging to group B as compared to patients of group A. This combination may thus replace routinely used combinations of opioids and local anaesthetics.