摘要
Since benzodiazepine/γ-amino butyric acid receptor was found in the spinal cord, there have been many studies to investigate analgesic effects of midazolam, a watersoluble benzodiazepine in the spinal cord. In animal experiments, intrathecal midazolam has analgesic effects on visceral pain, thermal pain, and inflammatory pain, and it has synergistic or additive effects with different kinds of analgesics acting on different receptors. In human study, intrathecal midazolam has analgesic effects on back pain, somatic pain, but not visceral pain. The analgesic effect lasts long and intrathecal midazolam induces sedation, which is the effect in the brain. Epidural midazolam is less studied than intrathecal midazolam. Epidural midazolam has segmental analgesia forpostoperative pain, and adding midazolam to bupivacaine increased duration of analgesia. It also induces sedation, which might be the effects of midazolam coming from cerebrospinal fluid to the brain. Some histopathological studies in animals showed neurotoxicity of midazolam, while there are no toxic side effects in many human studies of intrathecal and epidural midazolam. Therefore, we need clinically relevant animal studies for neurotoxicity and analysis of complications in patients already studied with intrathecal and epidural midazolam to give final conclusion.
Since benzodiazepine/γ-amino butyric acid receptor was found in the spinal cord, there have been many studies to investigate analgesic effects of midazolam, a watersoluble benzodiazepine in the spinal cord. In animal experiments, intrathecal midazolam has analgesic effects on visceral pain, thermal pain, and inflammatory pain, and it has synergistic or additive effects with different kinds of analgesics acting on different receptors. In human study, intrathecal midazolam has analgesic effects on back pain, somatic pain, but not visceral pain. The analgesic effect lasts long and intrathecal midazolam induces sedation, which is the effect in the brain. Epidural midazolam is less studied than intrathecal midazolam. Epidural midazolam has segmental analgesia forpostoperative pain, and adding midazolam to bupivacaine increased duration of analgesia. It also induces sedation, which might be the effects of midazolam coming from cerebrospinal fluid to the brain. Some histopathological studies in animals showed neurotoxicity of midazolam, while there are no toxic side effects in many human studies of intrathecal and epidural midazolam. Therefore, we need clinically relevant animal studies for neurotoxicity and analysis of complications in patients already studied with intrathecal and epidural midazolam to give final conclusion.
