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 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, with age range (20-60) years old received PCB
guided by using standard nerve stimulator. Patients were divided into three groups; 20 patient each:
group I received 0.5 ml/kg bupivacaine 0.5%, group II received 0.5 ml/kg bupivacaine 0.5% with 50
0/kg midazolam and group III received 0.5 ml/kg bupivacaine 0.5% with 1mg/kg tramadol. The onset
of sensory action, 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-value = 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-value = 0.04). The amount of analgesic consumed in
24h in group II was the least among all groups and amount consumed in 24h in group III was less than
group I (P-value <0.001). The incidence of occurrence of nausea was significantly high in group III
when compared with group I or group II (P-value = 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 (500/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.