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Indian Journal of Anesthesia and Analgesia

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Comparison of Fentanyl and Midazolam as Adjuvants to Low Dose Isobaric Ropivacaine for Spinal Anaesthesia for Transuretheral Resection of Prostate

Ashima Sharma, Professor and Head, Emergency Medicine, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082, India. , Mohammad Azharuddin1 , Ashima Sharma2 , Narmada Padhy3 , Padmaja Durga4 , Srinivas Mantha5 , Gopinath Ramchandran6

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Indian Journal of Anesthesia and Analgesia 4(3):p 580-584, July - September 2017. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4317.4

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Abstract

Background: Spinal ropivacaine provides differential anaesthesia with a higher sensory than motor block and is less cardiotoxic than bupivacaine. Small doses of ropivacaine (10- 15 mg) require addition of neuraxial adjuvants to improve the quality of block and duration of analgesia without affecting motor blockade. We designed a randomised double blind study to compare fentanyl and midazolam as additives to spinal ropivacaine 0.5% for patients scheduled for transuretheral resection of prostate (TURP). Methods: Forty patients scheduled for TURP were randomly assigned to group F (13.5mg isobaric ropivacaine 0.5% with 25 ug fentanyl) and group M (13.5 mg isobaric ropivacaine 0.5% with 1 mg midazolam). Evaluation of the performance of block, haemodynamics and side effects were recorded. A Minitab macro for MINITAB® Release 14.13 was used for pair-wise comparisons. Friedman’s Test was applied to estimate statistical significance. A P value 0.05 was considered significant. Results: The changes in heart rate, systolic and diastolic blood pressures were not found to significantly differ between the groups but intragroup differences were statistically very significant in both groups. The time to onset of block was same in both groups but midazolam( 15min) took a longer time to fix than fentanyl (10min). Subsequently, higher levels of block were noticed with midazolam. The time to achieve T10 block (P=0.93) and quality of motor block (P=0.81) were comparable between the two groups. Conclusions: Spinal anaesthesia with isobaric ropivacaine and fentanyl or midazolam provides an adequate sensory and motor blockade for elderly patients undergoing TURP.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4317.4

Keywords

Anesthesia; Spinal; Fentanyl; Hypotension; Midazolam. 

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