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LETTERS TO THE EDITOR

Paradoxical Increase in Pain Requirements with Midazolam Premedication

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

1. Ma H, Tang J, White PF, et al. Perioperative rofecoxib improves early recovery after outpatient herniorrhaphy. Anesth Analg 2004; 98: 970–5.[Abstract/Free Full Text]
2. Oxorn DC, Ferris LE, Harrington E, et al. The effects of midazolam on propofol-induced anesthesia: propofol dose requirements, mood profiles, and perioperative dreams. Anesth Analg 97; 85: 553–9.

Response

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

1. Ma H, Tang J, White PF, et al. Perioperative rofecoxib improves early recovery after outpatient herniorrhaphy. Anesth Analg 2004; 98: 970–5.
2. Shafer A, White PF, Urquhart ML, Doze VA. Outpatient premedication: use of midazolam and opioid analgesics. Anesthesiology 1989; 71: 495–501.[Web of Science][Medline]
3. Kain ZN, Sevarino F, Pincus S, et al. Attenuation of the preoperative stress response with midazolam: effects on postoperative outcomes. Anesthesiology 2000; 93: 141–7.[Web of Science][Medline]
4. Ong CK, Seymour RA, Tan JM. Sedation with midazolam leads to reduced pain after dental surgery. Anesth Analg 2004; 98: 1289–93.[Abstract/Free Full Text]
5. Oxorn DC, Ferris LE, Harrington E, et al. The effects of midazolam on propofol-induced anesthesia: propofol dose requirements, mood profiles, and perioperative dreams. Anesth Analg 1997; 85: 553–9.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Friedberg, B. L. Articles by White, P. F. Search for Related Content PubMed PubMed Citation Articles by Friedberg, B. L. Articles by White, P. F.