Preemptive analgesia with midazolam and diclofenac for hernia repair pain

Abstract

Purpose: The aim of this study was to compare the preemptive effects of systemic midazolam and diclofenac on postoperative analgesia when used before surgical incision.

Methods: Ninety patients, aged 35-65 years, scheduled for hernia repair surgery were included in the study. Forty five patients in the midazolam group (group M + D) received 0.05 mg/kg midazolam and 1.5 mg/kg diclofenac, 15 min before surgical incision; 45 patients in the diclofenac group (group D) received diclofenac without midazolam, 15 min before surgical incision. Postoperative pain (Verbal Rating Scale-6) score and first analgesic requirement were noted. Sedation levels were evaluated with Observer's Assessment of Alertness/Sedation (OAA/S) score. Adverse effects during and after the operation were also recorded.

Results: Group M + D had a significantly lower proportion of patients who exhibited postoperative pain than group D (11.1% vs. 37.7%, respectively; P < 0.05). The VRS-6 score in group M + D was 1.4 (range 0-4), whereas the corresponding score in group D was 2.4 (range 1-6). Mean (OAA/S) score in group M + D was lower than in the group D (1.5 ± 0.3 vs. 3.3 ± 0.4, respectively; P < 0.05). Duration of sedation in group M + D was significantly longer than the corresponding mean for group D (22.5 ± 6.4 vs. 12.1 ± 3.3 min, respectively; P < 0.01). The first postoperative analgesic request after surgery was 120 min in group M + D and 60 min in group D (P < 0.05).

Conclusion: Midazolam enhances the postoperative analgesic effects of diclofenac when used before the onset of noxious stimuli.