Razi Journal of Medical Sciences

    Background and Aim: Epidural-spinal anesthesia is one of the modern methods used to establish adequate anesthesia in cesarean section. In order to reduce these adverse effects different drugs are added to the anesthetic solution. The main aim of this article is evaluation of maternal and neonatal effects of adding Midazolam to Bupivacaine under combined spinal-epidural anesthesia in elective cesarean section Ptatients and Methods: This study has been designed as a double blind randomized clinical trial. Study population included pregnant females who were admitted to Hazrat Rasool Akram hospital to undergo elective cesarean section. Sampling was simple and nonrandomized. After considering the inclusion and exclusion criteria, and obtaining an informed consent, 90 pregnant women were divided by block randomization into 3 groups. Epidural-spinal anesthesia was achieved by using 2cc of 0.5% Bupivacaine. Based on their groups, group one (A) received only 0.5% Bupivacaine group two 2.5 mg of Midazolam along with 0.5% Bupivacaine and group 3, (C) 5 mg Midazolam with 0.5% Bupivacaine. Time duration of complete motor block, time duration of the highest score of sedation, time duration of required analgesia after surgery as well as, maternal and neonatal side effects were evaluated. To compare the qualitative and quantitalive data between the two groups, Chi sqaure test was used for normal distribution and for quantization variables, One Way ANOVA analysis of variance was used. Level of significance in this study was considered as 0.05. SPSS V. 13 was used for statistical analysis.

Results: Time of sensory motor block in Midazolam group was significantly less than Bupivacaine group this time for 5 mg Midazolam group was in the minimal range. The most sedative effects belonged to the midazolam
5 mg group. Adding Midazolam decreased significantly the time of requiring additional analgesia in mothers after surgery. The most prevalent complications that was reported by the mothers was nausea and vomiting more than 70% of mothers who received Bupivacaine alone complained of it.

  Conclusion: In this study it was shown that addition of Midazolam was associated with rapid onset of motor and sensory blocks along with maximum sedation. It also decreased the incidence of nausea and vomiting due to Bupivacaine. In addition maternal and neonatal side effects are not increased.