COMBINED DEXAMETHASONE AND MIDAZOLAM PRE-MEDICATION FOR POST-OPERATIVE PAIN CONTROL AMONG PATIENTS UNDERGOING SPINE SURGERY IN GENERAL ANESTHESIA

Tabish Hussain*, Asifa Anwar Mir, Vijay Parikh, Jawad Zahir

ABSTRACT

Introduction: There are various medicines and techniques available for prevention and treatment of post operative pain. Combination of various medicines and adjuvant therapy as multimodal analgesia has recently evolved as the main stay of pain treatment. The aim of this study was to determine the score and intensity of pain in the postoperative period while using Dexamethasone and Midazolam combination as pre-medication among patients undergoing general anesthesia for Spine Surgery by comparing with controls. Methods: The study was conducted at Department of Anesthesiology, Noor Specialist Hospital, Manama, Kingdom of Bahrain from 1st March 2021 to 30th Aug 2021 over a period of 6 months. The study design was a randomized control trial. A total of 50 patients undergoing open spine surgery were enrolled in the study. Patients were randomly divided in group A and B by consecutive non probability lottery method. Group A received 0.1 mg/Kg Midazolam oral 2 hour before surgery combined with 0.1mg/Kg Dexamethasone Intravenous (IV) and Group B were taken as controls. Post operative pain was measured by visual analog scale (VAS) in terms of pain scores at 2 hours postoperatively after the arrival of patient in the post-anaesthesia care unit (PACU). SPSS version 17.0 was used to analyze the data. Results: A total of 50 patients were included in the study. There were 25 patients in each group. With respect to individual visual analogue pain scores, there were 14 patients in group A who did not experienced any post operative pain in comparison to 4 patients in group B. Similarly there were 3 patients in group A, who reported a pain score of 1 where as 8 patients in group B had a VAP score of 1. There were 2 patients in group A and 7 patients in group B with VAP score of 2. For VAP score of 3, there were 2 patients in group A and 2 patients from group B. For a VAP score of 4, there were 2 patient in group A and 2 patients in group B. Two patients in both group A and group B experienced a VAP score of 5. All this data was significant with chi square p value of 0.05. Conclusion: In conclusion, oral Midazolam premedication in combination with injection Dexamethasone administered 2 hours before the spine surgery was effective in reducing postoperative pain. Further studies for evaluation of side effects, different dosing schedules and at different time intervals post operatively for both rest and dynamic pain are needed. 

Keywords: Spine Surgery, Midazolam, Dexamethasone, Pre-Medication, Postoperative Pain, General Anesthesia.