Fentanyl versus midazolam added to bupivacaine for spinal analgesia in children undergoing infraumbilical abdominal surgery: A randomized clinical trial

Background The addition of fentanyl or midazolam to intrathecal bupivacaine was tested to reduce the occurrence and pain degree in children undergoing infraumbilical surgery under sevoflurane anesthesia with intrathecal analgesia. Methodology Children (6-8 years) were randomized into three groups of 30 patients each with consent from parents. Groups C, F, and M received 0.3 mg/kg of 0.5% bupivacaine + 0.9% NaCl (placebo),0.3 mg/kg of 0.5% bupivacaine + 0.2 mu g/kg of fentanyl, and 0.3 mg/kg of 0.5% bupivacaine + 0.5 mg of midazolam, respectively. Assessments included time to first analgesic request, postoperative pain score, the total amount of rescue analgesics, motor and sensory blocks, sedation, family satisfaction, and adverse effects. Results The Children's Hospital of Eastern Ontario score was higher in the control than in the midazolam and fentanyl groups. The mean time to the first request for rescue analgesia was longer in group M (297.1 +/- 10.7 min) than in groups F (219.9 +/- 25.4 min) and C (162.7 +/- 37.5; P = 0.000). The total analgesic consumption was higher in both control and fentanyl groups (P = 0.044). Family satisfaction was significantly higher in group M (P = 0.013) with no adverse effects. Conclusion In the present study, intrathecal midazolam (0.5 mg) was superior to intrathecal fentanyl (0.2 mu g/kg) in increasing the duration of postoperative pain relief with lower postoperative pain scores and less incidences of adverse effects. Consequently, intrathecal midazolam can be used as an adjuvant to local anesthetics if fentanyl is not accessible or contraindicated.