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Volunteer Instructor in Clinical Anesthesia, University of Southern California, Los Angeles, CA
To the Editor:
Congratulations to Ma et al. (1) on their recent publication. While the administration of midazolam is a routine for most anesthesiologists, its inclusion in the Ma et al. protocol may confuse the issue of the efficacy of perioperative rofecoxib, inasmuch as Oxorn et al. (2) reported a statistically significant threefold incidence in midazolam premedicated patients requesting pain medication in recovery compared with those who did not receive midazolam.
References
Professor and Holder of the Margaret Milam McDermott Distinguished Chair in Anesthesiology, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, paul.white@utsouthwestern.edu
In Response:
Although the author’s congratulations are sincerely appreciated, the rationale for writing the letter is unclear. First, since patients in both treatment groups received a small dose of midazolam for premedication it would have no impact on the findings reported in our recent publication describing a placebo-controlled study (1). Second, numerous peer-reviewed publications have failed to find any evidence that midazolam produces a so-called paradoxical increase in the postoperative analgesic requirement. Dr. Friedberg is referred to a study by Shafer et al. (2) published in 1989. In fact, recent studies (3,4) suggest that the preoperative administration of midazolam may actually decrease postoperative pain. The study by Oxorn et al. (5) was not designed to evaluate the effect of midazolam on the postoperative analgesic requirements.
References
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