ARTICLE
Post-traumatic stress and awareness in patient with traumatic lower limb surgery by neuraxial anesthesia: A randomized clinical trial
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1
Department of Anesthesiology and Pain Medicine, Kerman University of Medical Sciences, Kerman, Iran
2
Department of Orthopedic Surgery, Kerman University of Medical Sciences, Kerman, Iran
3
Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran
4
Department of Urology, Kerman University of Medical Sciences, Kerman, Iran
5
Endocrinology and Metabolism Research Center, Institute of Basic and Clinical PhysiologySciences, Kerman University of Medical Sciences Kerman, Iran
Submission date: 2022-07-17
Final revision date: 2023-01-04
Acceptance date: 2023-01-07
Online publication date: 2023-06-22
Publication date: 2023-06-22
Corresponding author
Ladan Amirkhosravi
Endocrinology and Metabolism Research Center, Institute of Basic and Clinical PhysiologySciences, Kerman University of Medical Sciences Kerman, Iran
Arch Psych Psych 2023;25(2):30-36
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ABSTRACT
Aim of the study:
Anesthesia decreases brain cognitive function, memory and pain, and also leads to the loss of consciousness. In this study, midazolam and propofol-sedated trauma patients undergoing lower limb surgery were evaluated for stress levels after neuraxial anesthesia.
Subject or material and methods:
This double-blind randomized clinical trial was conducted on patients with lower extremity fractures due to trauma, who were candidates of elective lower extremity orthopedic surgery. Patients were randomly divided into two groups of propofol-sedated patients (n=110) and midazolam-sedated patients (n=110) after neuraxial anesthesia. Then, all patients underwent spinal anesthesia using 3 ml of 0.5% bupivacaine (3 mg/kg). Propofol (25-75 µg/kg/minute) was infused, and 1-2 mg of midazolam was injected PRN until patients reached the score of 3 on the Modified Observers' Assessment of Alertness/ Sedation Scale (MOAA/S).
Results:
Preoperative sedation/alertness scores of patients in the two groups did not differ significantly from one another. Penetrating memories in the midazolam group was higher than the propofol group (P<0.05). Personal relationship problem was more significant in the midazolam group than the propofol group (P<0.05). Inability in controlling emotional feelings was higher in the midazolam group compared to the propofol group (P<0.001).
Discussion:
Our findings indicated that a sub-hypnotic dose of propofol provided superior sedation and amnesia compared to midazolam. Aspects of stress, including penetrating memories, personal relationship problems, inability to control emotional feelings, and lack of depression during spinal anesthesia were better managed by propofol compared to midazolam.
Conclusions:
Propofol infusion was better in decreasing stress levels after surgery compared to midazolam.