TRAMADOL VERSUS MIDAZOLAM IN PSOAS COMPARTMENT BLOCK (LUMBAR PLEXUS BLOCK) WITH BUPIVACAINE FOR LOWER LIMB SURGERIES

Abstract

Background: The psoas compartment block (PCB) is a deep block of the lumbar plexus from
a posterior approach. It was used to provide anesthesia for thigh surgery, for analgesia after
total hip or knee arthroplasty. This study aimed to compare between the combined use of
either tramadol or midazolam with bupivacaine in psoas compartment block for postoperative
analgesia as regard the onset of action, duration of the block and any recorded side effects.
Methods: In a randomized double blind prospective study, 60 patients, ASA I & II, scheduled
for knee surgery under total intravenous anesthesia., the age range (20-60) years old they
received successful PCB guided by standard nerve stimulator. Patients were divided into
three groups;: group I received 0.5 ml/kg bupivacaine 0.5%, group II received 0.5 ml/kg
bupivacaine 0.5% with 50 //kg midazolam and group III received 0.5 ml/kg bupivacaine
0.5% with 1mg/kg tramadol. The onset and duration of the block, pain score every 2hs,
degree of motor block, heamodynamic changes, amount of analgesic consumed in the first
postoperative 24hs and any side effects were noticed and recorded.
Results: Duration of the block in group II was significantly longer than the other two groups
(P = 0.0016). There was significant decrease in pain score at 2 hours in group II and in group
III in comparison with group I (P = 0.04). The amount of analgesic consumed in 24h in group
II was the least among all groups and in group III it was lesser than group I (P <0.001). The
incidence of occurrence of nausea was significantly high in group III when compared with
group I or group II (P = 0.047). No significant differences between groups regarding onset of
sensory block, degree of motor block, heamodynamic changes, shivering, pruritis, vomiting
and respiratory depression.
Conclusion: addition of midazolam (50//kg) to bupivacaine gives better results than addition
of tramadol (1mg/kg) to bupivacaine in psoas compartment block regarding duration of
sensory block, amount of analgesic needed in the first 24 hours and incidence of nausea. Both
of midazolam and tramadol have the same effects as regard the other parameters of
comparison.
Key wards: Psoas compartment block, midazolam, tramadol, bupivacaine postoperative
analgesia.