COMPARISON OF DEXMEDETOMIDINE AND MIDAZOLAM FOR SEDATION DURING REGIONAL ANAESTHESIA: A HOSPITAL BASED STUDY
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Keywords
Dexmedetomidine, Midazolam, Sedation, Regional anaesthesia, Ramsay Sedation Score, Recovery time etc.
Abstract
Background: Sedation during regional anaesthesia (RA) enhances patient comfort, reduces anxiety, and improves surgical conditions. Dexmedetomidine and midazolam are commonly used sedative agents; however, they differ significantly in their pharmacological profiles, onset, recovery characteristics, and side-effect profiles. This prospective, randomized study was conducted to compare the efficacy, safety, and recovery profiles of dexmedetomidine and midazolam when used for intraoperative sedation in patients undergoing surgery under regional anaesthesia.
Methods: A total of 112 adult patients undergoing elective lower abdominal or lower limb surgeries under regional anaesthesia were enrolled and randomized into two equal groups. Group D received a loading dose of dexmedetomidine (1 µg/kg over 10 minutes) followed by an infusion of 0.2–0.7 µg/kg/h. Group M received midazolam at 0.03–0.07 mg/kg IV bolus followed by intermittent doses. Sedation levels were assessed using the Ramsay Sedation Scale (RSS), and vital parameters including heart rate, blood pressure, and oxygen saturation were monitored throughout. Time to reach target sedation, recovery time, patient satisfaction scores, and adverse events were recorded.
Results: Dexmedetomidine resulted in significantly higher sedation scores (mean RSS 3.6 ± 0.4) compared to midazolam (RSS 3.1 ± 0.5, p<0.001). The mean time to achieve sedation was slightly longer with dexmedetomidine (8.1 ± 2.2 min) than with midazolam (6.2 ± 1.8 min), but recovery was significantly faster in the dexmedetomidine group (14.8 ± 3.5 min vs. 21.3 ± 4.2 min, p<0.001). Patient satisfaction scores were higher in the dexmedetomidine group (mean VAS 8.6 ± 1.1 vs. 7.2 ± 1.3). Hemodynamic fluctuations such as bradycardia and hypotension were more common with dexmedetomidine but were mild and manageable. Oxygen desaturation occurred only in the midazolam group (5.4%).
Conclusion: Dexmedetomidine is superior to midazolam for sedation during regional anaesthesia, offering better sedation depth, faster recovery, and higher patient satisfaction, with minimal respiratory compromise. It should be considered the preferred agent for intraoperative sedation, especially in patients where respiratory preservation and rapid postoperative recovery are crucial.
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Dr Diptanu Bhaumik
Assistant Professor, Department of Anaesthesiology, ICARE Institute of Medical Sciences and Research & Dr B C Roy Hospital, Haldia, West Bengal, Pincode 721645.
Dr Koushik Baran Roy
Post Graduate Resident, Department of Anaesthesiology, ICARE Institute of Medical Sciences and Research & Dr B C Roy Hospital
Dr Deepak Chandra
Associate Professor, Department of Anaesthesiology, ICARE Institute of Medical Sciences and Research & Dr B C Roy Hospital
Dr Arup Dasgupta
Professor and HOD, Department of Anaesthesiology, ICARE Institute of Medical Sciences and Research & Dr B C Roy Hospital