Canadian Journal of Anesthesia

, Volume 52, Issue 8, pp 822–826 | Cite as

Brachial plexus block with midazolam and bupivacaine improves analgesia

  • Koj Jarbo
  • Yatindra Kumar Batra
  • Mnams Nidhi
  • Bidyut Panda



Adjuncts to local anesthetics for brachial plexus block may enhance the quality and duration of analgesia. Midazolam, a water-soluble benzodiazepine, is known to produce antinociception and enhance the effect of local anesthetics when given epidurally or intrathecally. The purpose of this study was to assess the effect of midazolam added to brachial plexus anesthesia.


A prospective, randomized, double blind study was conducted on 40 ASA I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly divided into two groups. Patients in Group B (n = 20) were administered 30 mL of 0.5% bupivacaine and Group BM (n = 20) were given 30 mL of 0.5% bupivacaine with midazolam 50 μg·kg-1. Hemodynamic variables (i.e., heart rate, noninvasive blood pressure), pain scores and rescue analgesic requirements were recorded for 24 hr postoperatively.


The onset of sensory and motor block was significantly faster in Group BM compared to Group B (P < 0.05). Pain scores were significantly higher in Group B compared to Group BM from two hours to 24 hr postoperatively (P < 0.05). Rescue analgesic requirements were significantly less in Group BM compared to Group B (P < 0.05). Hemodynamics and sedation scores did not differ between groups in the postoperative period.


Midazolam (50 μg·kg-1) in combination with 30 mL of bupivacaine (0.5%) hastened onset of sensory and motor block, and improved postoperative analgesia when used in brachial plexus block, without producing any adverse events. Objectif : Un ajout aux anesthésiques locaux pour le bloc du plexus brachial peut améliorer la qualité et la durée de ľanalgésie. Le midazolam, une benzodiazépine hydrosoluble, administré par voie péridurale ou intrathécale, produit de ľantinociception et améliore ľeffet des anesthésiques locaux. Nous avons évalué ľeffet du midazolam ajouté à ľanesthésie du plexus brachial.


Midazolam Bupivacaine Motor Block Sensory Block Sedation Score 
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Le bloc du plexus brachial avec du midazolam et de la bupivacaïne améliore ľanalgésie



Une étude prospective, randomisée et à double insu a été menée auprès de 40 adultes ďétat physique ASA I ou II devant être opérés aux membres supérieurs sous anesthésie supraclaviculaire du plexus brachial. Les patients ont été répartis aléatoirement en deux groupes. Ceux du groupe B (n = 20) ont reçu 30 mL de bupivacaïne à 0,5 % et ceux du groupe BM (n = 20) ont eu 30 mL de bupivacaïne à 0,5 % avec 50 μg·kg-1 de midazolam. Les variables hémodynamiques, les scores de douleur et les demandes ďanalgésiques de secours ont été notés pendant 24 h après ľopération.


Le délai ďinstallation du bloc sensitif et moteur a été significativement plus court chez les patients du groupe BM, comparé au groupe B (P < 0,05). De 2 h à 24 h après ľopération, les douleurs ont été plus importantes dans le groupe B (P <0,05) et les demandes ďanalgésiques de secours ont été moindres dans le groupe BM (P < 0,05). Après ľopération, ľhémodynamique et les scores de sédation ne différaient pas ďun groupe à ľautre.


Le midazolam (50 µg·kg-1) combiné à 30 mL de bupivacaïne (0,5 %) a accéléré ľinstallation du bloc sensitif et moteur et amélioré ľanalgésie postopératoire sans produire ďeffets indésirables lors du bloc du plexus brachial.


  1. 1.
    Lund PC, Cwik JC, Vallesteros F. Bupivacaine-a new long-acting local anesthetic agent. A preliminary clinical and laboratory report. Anesth Analg 1976; 49: 103–13.Google Scholar
  2. 2.
    DeJong RH. Axillary block of brachial plexus. Anesthesiology 1961; 22: 215–25.Google Scholar
  3. 3.
    de Jong RH, Wagman IH. Physiological mechanisms of peripheral nerve block by local anesthetics. Anesthesiology 1963; 24: 684–727.CrossRefGoogle Scholar
  4. 4.
    McGlade DP, Kalpokas MV, Mooney PH, Chamley D, Mark AH, Torda TA. A comparison of 0.5% ropivacaine and 0.5% bupivacaine for axillary brachial plexus anesthesia. Anaesth Intensive Care 1998; 26: 515–20.PubMedGoogle Scholar
  5. 5.
    Bazin JE, Massoni C, Bruelle P, Fenies V, Groslier D, Schoeffler P. The addition of opioids to local anaesthetics in brachial plexus block: the comparative effects of morphine, buprenorphine, and sufentanil. Anaesthesia 1997; 52: 858–62.PubMedCrossRefGoogle Scholar
  6. 6.
    Culebras X, Van Gessel E, Hoffmeyer P, Gamulin Z. Clonidine combined with a long acting local anaesthetic does not prolong postoperative analgesia after brachial plexus block but does induce hemodynamic changes. Anesth Analg 2001; 92: 199–204.PubMedCrossRefGoogle Scholar
  7. 7.
    Bone HG, Van Aken H, Brooke M, Burkle H. Enhancement of axillary brachial plexus block anesthesia by coadministration of neostigmine. Reg Anesth Pain Med 1999; 24: 405–10.PubMedCrossRefGoogle Scholar
  8. 8.
    Keeler JF, Simpson KH, Ellis FR, Kay SP. Effect of addition of hyaluronidase to bupivacaine during axillary brachial plexus block. Br J Anaesth 1992; 68: 68–71.PubMedCrossRefGoogle Scholar
  9. 9.
    Bedder MD, Kozody R, Craig DB. Comparison of bupivacaine and alkalinized bupivacaine in brachial plexus anesthesia. Anesth Analg 1988; 67: 48–52.PubMedGoogle Scholar
  10. 10.
    Edwards M, Serrao JM, Gent JP, Goodchild CS. On the mechanism by which midazolam causes spinally mediated analgesia. Anesthesiology 1990; 73: 273–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Nishiyama T, Yokoyama T, Hanaoka K. Midazolam improves postoperative epidural analgesia with continuous infusion of local anaesthetics. Can J Anaesth 1998; 45: 551–5.PubMedGoogle Scholar
  12. 12.
    Kim MH, Lee YM. Intrathecal midazolam increases the analgesic effects of spinal blockade with bupivacaine in patients undergoing haemorrhoidectomy. Br J Anaesth 2001; 86: 77–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Brown DA, Marsh S. Axonal GABA-receptors in mammalian peripheral nerve trunks. Brain Res 1978; 156: 187–91.PubMedCrossRefGoogle Scholar
  14. 14.
    Bhisitkul RB, Villa JE, Kocsis JD. Axonal GABA receptors are selectively present on normal and regenerated sensory fibers in rat peripheral nerves. Exp Brain Res 1987; 66: 659–63.PubMedCrossRefGoogle Scholar
  15. 15.
    Cairns BE, Sessle BJ, Hu JW. Activation of peripheral GABAA receptors inhibits temporomandibular jointevoked jaw muscle activity. J Neurophysiol 1999; 81: 1966–9.PubMedGoogle Scholar
  16. 16.
    Winnie AP, Tay CH, Patel KP, Ramamurthy S, Durrani Z. Pharmacokinetics of local anaesthetics during plexus blocks. Anesth Analg 1977; 56: 852–61.PubMedCrossRefGoogle Scholar
  17. 17.
    Gulec S, Buyukkidan B, Oral N, Ozcan N, Tanriverdi B. Comparison of caudal bupivacaine, bupivacainemorphine and bupivacaine-midazolam mixtures for post-operative analgesia in children. Eur J Anaesthesiol 1998; 15: 161–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Batra YK, Jain K, Chari P, Dhillon MS, Shaheen B, Reddy GM. Addition of intrathecal midazolam to bupivacaine produces better post-operative analgesia without prolonging recovery. Int J Clin Pharmacol Ther 1999; 37: 519–23.PubMedGoogle Scholar
  19. 19.
    Serrao JM, Marks RL, Morley SJ, Goodchild CS. Intrathecal midazolam for the treatment of chronic mechanical low back pain: a controlled comparison with epidural steroid in a pilot study. Pain 1992; 48: 5–12.PubMedCrossRefGoogle Scholar
  20. 20.
    Serrao JM, MacKenzie JM, Goodchild CS, Gent JP. Intrathecal midazolam in the rat: an investigation of possible neurotoxic effects. Eur J Pharmacol 1990; 7: 115–22.Google Scholar
  21. 21.
    Nishiyama T, Matsukawa T, Hanaoka K. Acute phase histopathological study of spinally administered midazolam in cats. Anesth Analg 1999; 89: 717–20.PubMedCrossRefGoogle Scholar
  22. 22.
    Schweiger IM, Jorge-Costa M, Pizzolato GP, Foster A, Morel DR. Intrathecal midazolam reduces isoflurane MAC and increases the apnoeic threshold in rats. Can J Anaesth 1994; 41: 144–8.CrossRefGoogle Scholar
  23. 23.
    Tucker AP, Mezzatesta J, Nadeson R, Goodchild CS. Intrathecal midazolam II: combination with intrathecal fentanyl for labor pain. Anesth Analg 2004; 98: 1521–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Tucker AP, Lai C, Nadeson R, Goodchild CS. Intrathecal midazolam I: a cohort study investigating safety. Anesth Analg 2004; 98: 1512–20.PubMedCrossRefGoogle Scholar
  25. 25.
    Reeves JG, Fragen RJ, Vinik HR, Greenblatt DJ. Midazolam: phamacology and uses. Anesthesiology 1985; 62: 310–24.CrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  • Koj Jarbo
    • 1
  • Yatindra Kumar Batra
    • 1
  • Mnams Nidhi
    • 1
  • Bidyut Panda
    • 1
  1. 1.Department of Anesthesia and Intensive Care UnitPostgraduate Institute of Medical Education and ResearchChandigarhIndia

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