Intrathecal Midazolam Combined with Low-dose Bupivacaine Improves Postoperative Recovery in Diabetic Mellitus Patients Undergoing Foot Debridement

低劑量的Bupivacaine配合Midazolam為糖尿病患作脊椎麻醉進行足部手術有助改善術後恢復

吳俞樺(Yu-Wha Wu) ； 蕭介民(Jieh-Min Shiau) ； 洪國全(Chao-Chun Hong) ； 洪志鵬(Chih-Peng Hung) ； 鹿曉楓(Hsiao-Feng Lu) ； 曾稼志(Chia-Chih Tseng)

《Acta Anaesthesiologica Taiwanica》 43卷3期 (2005/09) Pp. 129-134

摘要

Background: Intrathecal midazolam acts synergically with other anesthetics to relieve surgical pain, and the drug combination may decrease complications attributable to each component drug. This prospective study was to determine the spinal effects of low-dose of bupivacaine (5mg) combined with intrathecal midazolam (2mg) in diabetes mellitus (DM) patients undergoing foot debridement.
Methods: Sixty diabetic patients were admitted for foot debridement under spinal anesthesia were equally divided into two groups. Group 1 (M) received 7.5mg of hyperbaric bupivacaine; group 2 (M+M) received 5mg of hyperbaric bupivacaine combined with 2 mg of midazolam intrathecally. The intensity of motor block was assessed with modified Bromage scale 20 minutes after injection, and at 0, 30, 60, 90 and 120 min after arriving at the post anesthesia care unit (PACU). Pain score was assessed with a 10cm visual analog scale (VAS, 0=no pain and 10=intolerable pain) at 0, 1, 2, 6 h and 24 h postoperatively.
Results: Anesthesia was smooth in all patients except one in group M, whose analgesia was inadequate and general anesthesia was given to complete the surgery. The number of patients who sustained moderate to severe pain (VAS＞5) was significantly less in the M+M group than in M group as accessed 6 and 24 h postoperatively. The requirement of additional analgesic as reinforcement was significantly less in the M+M group than in the M group within the space of 24 h postoperatively. Recovery of motor function was significantly faster in the M+M group.
Conclusions: The combination of intrathecal midazolam and bupivacaine was a safe and effective anesthetic technique, and it also provided early recovery of motor function and reduced the requirement of analgesics postoperatively.

關鍵字

脊椎內注射 ； Bupivacaine ； 糖尿病足 ； 清創

並列摘要

Background: Intrathecal midazolam acts synergically with other anesthetics to relieve surgical pain, and the drug combination may decrease complications attributable to each component drug. This prospective study was to determine the spinal effects of low-dose of bupivacaine (5mg) combined with intrathecal midazolam (2mg) in diabetes mellitus (DM) patients undergoing foot debridement.
Methods: Sixty diabetic patients were admitted for foot debridement under spinal anesthesia were equally divided into two groups. Group 1 (M) received 7.5mg of hyperbaric bupivacaine; group 2 (M+M) received 5mg of hyperbaric bupivacaine combined with 2 mg of midazolam intrathecally. The intensity of motor block was assessed with modified Bromage scale 20 minutes after injection, and at 0, 30, 60, 90 and 120 min after arriving at the post anesthesia care unit (PACU). Pain score was assessed with a 10cm visual analog scale (VAS, 0=no pain and 10=intolerable pain) at 0, 1, 2, 6 h and 24 h postoperatively.
Results: Anesthesia was smooth in all patients except one in group M, whose analgesia was inadequate and general anesthesia was given to complete the surgery. The number of patients who sustained moderate to severe pain (VAS＞5) was significantly less in the M+M group than in M group as accessed 6 and 24 h postoperatively. The requirement of additional analgesic as reinforcement was significantly less in the M+M group than in the M group within the space of 24 h postoperatively. Recovery of motor function was significantly faster in the M+M group.
Conclusions: The combination of intrathecal midazolam and bupivacaine was a safe and effective anesthetic technique, and it also provided early recovery of motor function and reduced the requirement of analgesics postoperatively.

並列關鍵字

Injections, spinal ； Bupivacaine ； Diabetic foot ； Debridement