Journal of Anesthesiology and Pain

Aim and Background:

Adding new supplements when performing spinal anesthesia can

increase the duration of analgesia. The aim of the present study has been to compare intrathecal

midazolam and tramadol with the conventional method for postoperative pain and shivering

control after elective caesarean section.

Methods and Materials:

In this double-blind clinical trial, 210 ASA class I,II women, aged 20-

35 years, candidate for elective caesarean section were randomly allocated to three groups. All

patients received hyperbaric intrathecal lidocaine and additionally group I received 2 mg

subarachnoid midazolam, group II received 25 mg subarachnoid tramadol and the control group

received 5cc normal saline. Postoperative pain score, the painless duration and postoperative

shivering were assessed in the three groups.

Findings:

The mean painless duration in tramadol, midazolam and the control group were

192.5±12.2, 111.3±16.6 and 86.1±9.9 minutes, respectively (p<0.001). The mean painless

duration in the midazolam group was significantly more than two other groups and this duration

in the tramadol group was also more than the control one. The mean postoperative pain score,

shivering occurrence and the frequency of requested painkiller in the first 24 hours, were also

compared. In the midazolam group, they were all significantly less than the two other groups. In

the meanwhile, these indexes in the tramadol group were less than the control one (p<0.001).

Conclusions:

Adding intrathecal midazolam and tramadol to lidocaine 5% in elective caesarean

section can increase the painless duration and lead to a reduction in postoperative shivering.

Midazolam demonstrates a stronger effect.