The efficacy of different doses of Midazolam added to Lidocaine for upper extremity Bier block on the sensory and motor block characteristics and postoperative pain

Azim Honarmand, Mohammadreza Safavi, Koorosh Nemati, Padideh Oghab, Azim Honarmand, Mohammadreza Safavi, Koorosh Nemati, Padideh Oghab

Abstract

Objective: This study was designed to evaluate the effect of different doses of midazolam on anesthesia and analgesia quality when added to lidocaine during the intravenous regional anesthesia (IVRA).

Methods: One hundred and forty patients underwent hand surgery were randomly allocated into four groups to receive 3 mg/kg lidocaine 2% diluted with saline to a total volume of 40 mL in the control Group L-C (n = 35), 30 μg/kg midazolam plus 3 mg/kg lidocaine 2% diluted with saline to a total volume of 40 mL in the midazolam Group L-M1 (n = 35), 40 μg/kg midazolam plus 3 mg/kg 2% lidocaine diluted with saline to a total volume of 40 mL in the midazolam Group L-M2 (n = 35), and 50 μg/kg midazolam plus 3 mg/kg lidocaine 2% diluted with saline to a total volume of 40 mL in the midazolam Group L-M3 (n = 35). Sensory and motor block and recovery times, tourniquet pain, intra-operative analgesic requirement, and visual analog scale (VAS) scores were recorded.

Findings: Onset time of sensory and motor block in L-M3 Group was shorter than the L-M2 and L-M1 and L-C Groups (P < 0.001). Furthermore, prolonged sensory (P = 0.005) and motor recovery time (P = 0.001) in L-M3 were longer than the other groups. Intra-operative VAS score and intra-operative fentanyl consumption in L-M3 were lower than the other groups (P < 0.001). The numbers of patients needed to pethidine in Group L-M3 were significantly less compared with the other groups (P = 0.035). VAS scores were significantly lower in Group L-M3 in different time intervals in the postoperative period compared with the other groups (P < 0.001).

Conclusion: Addition of 50 μg/kg midazolam for IVRA (Group L-M3) enhanced intra-operative analgesia and improved anesthesia quality better than other groups receiving lower midazolam doses as well as a control group.

Keywords: Anesthetic techniques; Midazolam; intravenous regional Lidocaine; postoperative analgesics; tourniquet pain.

Conflict of interest statement

Conflict of Interest There are no conflicts of interest.

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