Intrathecal Midazolam: A Review on the Drug's Pharmacological Features, as Well as Its Therapeutic Efficacy and Side Effects

Introduction: Spinal anaesthesia with lignocaine was highly popular earlier for short surgical procedures as it had a predictable onset and provided dense sensory and motor blockade of moderate duration. Unfortunately, some reports of neurotoxicity had cast doubts on the intrathecal use of lignocaine. Post operative pain relief is an unresolved issue. One of the methods of providing postoperative analgesia is by prolonging the duration of intrathecal hyperbaric bupivacaine (0.5%) by adding various drugs such as opioids, midazolam, clonidine, ketamine, neostigmine etc. Discovery of benzodiazepine receptors in the spinal cord triggered the use of intrathecal midazolam for analgesia.

Methodology: This review article was prepared after a thorough study of the literature using data search engine such as ‘Pubmed’. This article referred to prior Randomized Controlled Trial (RCT) on Intrathecal Midazolam.

Review Findings: Midazolam is a potent short acting benzodiazepine that has been shown to have anti-nociceptive effects when administered intrathecally both in laboratory animals and in humans. Preservative free midazolam is also being used in recent times. As an additive to intrathecal hyperbaric bupivacaine to prolong the quality and duration of analgesia. It is said to be associated with less side effects compared to neuraxial opioids.

Conclusion: Intrathecal midazolam can be used for postoperative pain relief. It can prolong the duration of analgesia and prolonged motor and sensory block without any significant hemodynamic compromise.