مقايسه اثر تزريق داخل نخاعي ميدازولام و فنتانيل بر ميزان نمره درد حاد در بيماران با شكستگي اندام تحتاني (زير زانو)

Comparison the effect of Intrathecal Midazolam on Acute Pain Score in Fentanyl in Lower Limb Fractures (below the Knee)

Background: Intrathecal injections are one of the available modalities for patientʹs pain relief. This study assessed the efficacy of the analgesic property of a benzodiazepine (midazolam; with approved analgesic effect when administered intrathecally, IT) against an opioid (fentanyl; an analgesic drug without any local anesthetic properties when used IT). Based on previous studies, midazolam has less side effects on hemodynamics and respiratory system in contrast with other drugs used intrathecally for pain relief. Materials and Methods: This survey has been done as a randomized clinical trial on 60 patients with lower limb fractures (below the knee; within 24 hrs of injury) referred to Imam Hossein and Loghman-aldoleh acute pain service. Based on the inclusion criteria, patients were divided randomly into M group (midazolam used IT) or F group (fentanyl used IT). The intrathecal (IT) injection was done after the primary evaluations of patientsʹ vital signs, oletermination of intravenous fluids and determining the acute pain score in each group based on VAS scores. After 15 minutes of injection, the patientsʹ new pain score were assessed again. All patients underwent general anesthesia on a predetermined protocol. All the surgical procedures were done in less than 2 hours. Results: It was shown in this study that injection of midazolam IT is significantly more effective in acute pain relief than fentanyl as the acute pain score reduction in M group was 3.06±1.617 while in F group was 1.46 ±0.507 (p-value<0.001). The pain-free time (VAS<4) duration after the surgical procedure in the ward was significantly more in the midazolam group [for midazolam was 7:15ʹ (CI. 95%: 6.6-7.8) as against fentanyl group was 3:30ʹ (CI. 95%:3.3-3.7)]. Conclusion: Acute pain was relieved more effectively in patients recieving midazolam used IT (4mg) in comparison with fentanyl (40|ig). More studies are needed to assess the analgesic properties of IT midazolam and itʹs therapeutical considerations in other types of pain such as chronic and neuropathic pains