Introduction

In India surgery for lower lib, perennial region and lower abdominal commonly done by regional central nuro-axial block. Spinal anesthesia is safer option for lower abdomen, perineal and lower limb surgery. Bupivacaine is the most widely used drug for spinal anesthesia, however in higher doses it is associated with various complications. To keep the dosage of bupivacaine, minimum and reduce the side effects, various adjuvant have been tried to improve the sensory and motor blockade

Pain is a sensory-physical and emotional experience, it is always worry both patient and clinician. Issue of postoperative pain still not completely resolved. Due to pain, postsurgical patients are often unable to, move enough to their own daily needs or participate in their own rehabilitation. Postoperative pain relief helps in early mobilization of the patient good outcome, reduced morbidity and patient satisfaction.

There are various methods used to relieve pos-operatives pain such as postoperative oral opioids, parenteral drugs, local infiltration of drug, intrathecal or extradural drug administration. Regional analgesia has fewer side effects compare to systemic analgesia. One of the methods of providing effective postoperative analgesia is by prolonging the duration of intrathecal  bupivacaine by additives such as opioids, clonidine, ketamine, midazolam⁽²’³’⁴’⁵⁾ etc. However, each drug has its own limitations and a need for alternative methods.

Discovery of benzodiazepine receptors in spinal cord triggered the use of intrathecal midazolam for analgesia⁽⁶⁾.Midazolam is known to produce antinociception and potentiate the effect of local anesthetic when given in neuraxial block without having significant side effects.

1. Mohler H, Okada T. Benzodiazepine receptor: Demonstration in central nervous system. Science 1977; 198: 849-51.
2. Venkateswaran R, Prasad KN. Management of post op pain. IJA 2006; 50:345-54.
3. Faull RLM, Villiger JW. Benzodiazepine receptors in human spinal cord : A detailed anatomical and pharmacological study. Neuroscience 1986 ; 17: 791-802.
4. Agrawal N, Usmani A, Sehgal R, Kumar R, Bhadoria P. Effect of intrathecal midazolam bupivacine combination on post op analgesia. Indian J Anaesth 2005;49:37-9.
5. Valentine JM, Lyons G, Bellamy MC. The effect of intrathecal midazolam on post-operative pain. Eur J Anaesthesiol 1996;13:589-93
6. Bhattacharya D, Biswas B, Banerjee A. Intrathecal midazolam with bupivacaine increases the analgesic effect of spinal blockade after major gynaecological surgery. J Anaesth Clin Pharmacol 2002;18:183-6.
7. Vaswani RK, Raiger LK, Bajaj P. h  e ef  ect of intrathecal midazolam on   postoperative pain relief in orthopedic surgery. Hosp Today 2002;4:217-20.

Dr Sohail Ahmad

Asst. Professor, Dept. of Anesthesia, K.M.C., Katihar