الفهرس 
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Abstract
Subarachnoid block achieved a wide spread popularity as a simple and effective method of anesthesia for elective cesarean sections. Among the local anesthetics, bupivacaine is the most commonly used drug for subarachnoid block.
The use of intrathecal adjuvants has gained popularity, with the intention of reducing the dose of local anesthetics, maintaining hemodynamic stability, delaying the onset of pain during the postoperative period, and thus reducing the demand for postoperative rescue analgesics.
Fentanyl, a short-acting lipophilic opioid, is known to augment the quality of subarachnoid block. Midazolam is an imidazobenzodiazepine with unique properties when compared with other benzodiazepines. Studies have revealed advantage of intrathecal injection of both drugs in enhancing the analgesic effect of bupivacaine after CS.
This study was conducted to evaluate and compare the effects of intrathecal midazolam and fentanyl as additives to intrathecal hyperbaric bupivacaine with regards to onset and duration of sensory block, duration of complete and effective analgesia and side effects associated with the drug.
This study included 90 women aged between 18-35 years scheduled to undergo elective cesarean section under spinal anesthesia. Patients were subdivided randomly into 3 groups (30 patients each) on the basis of the adjuvant added to the anesthetic used; group A (Fentanyl + bupivacaine), group B (Midazolam + bupivacaine) and group C (Bupivacaine).
Before surgery, the patients were transferred to the operation theatre and they were connected to all noninvasive monitors. Pulse and non-invasive arterial blood pressure (BP) were noted for every patient.
The effect of different drugs on the sensory, motor analgesic was monitored after the induction of anesthesia. Post operative pain assessment of pain, vital signs and complications were recoreded for every case.
The state of the neonates was assessed using 1 and 5 minute/s APGAR score.
Demographic data did not differ between the three study groups (p > 0.05). group A showed a significantly earlier onset of sensory block (p =0.005), motor block (p = 0.009), as well as late regression to L1 sensory level (p <0.001). Additionally, longer analgesia (p < 0.05) and longer time before the first call for analgesics (p = 0.005) was associated with group A.
The required dose of paracetamol and pethidine within the first day were significantly lower in group A and group B in comparison to group C.
However, complications encountered did not differ between the three study groups (p > 0.05). Also, the state of the neonates didn’t show significant difference between the three groups.