Midazolam as an antiemetic in patients receiving epidural morphine for postoperative pain relief


  • Mokhtar Elhakim, MD
  • Hany Abd Elfattah, MD
  • Dalia Nasr El-Din, MD
  • Reem El-Kabarity, MD
  • Azia Atef, MD
  • Atef El-Fakey, MD




midazolam, nausea, vomiting


Purpose: Epidural morphine has been associated with a significant incidence of postoperative nausea and vomiting (PONV). The authors have evaluated the prophylactic effects of midazolam in preventing nausea and vomiting following epidural morphine for postoperative pain control.
Methods: The authors studied 80 women (n = 40 in each group) undergoing total abdominal hysterectomy under epidural anesthesia, in a randomized, double-blind, placebo-controlled study. At the end of the surgery, all patients received epidural morphine 3 mg for postoperative pain. Before morphine injection, the midazolam group received lowdose midazolam infusion (1 mg bolus followed by 1 mg h-1), while the placebo group received IV saline.
Results: Patients in the midazolam group reported a lower incidence of total PONV, and a lower frequency of rescue antiemetic request than those in the placebo group (p < 0.05). In addition, midazolam was associated with a reduced incidence of pruritus following epidural morphine (p < 0.05).
Conclusion: The authors conclude that low-dose midazolam infusion is effective in the prevention of nausea, vomiting, and pruritus following epidural morphine for postoperative pain control.

Author Biographies

Mokhtar Elhakim, MD

Department of Anaesthesia, Faculty of medicine, Ain-Shams University, Cairo, Egypt.

Hany Abd Elfattah, MD

Department of Anaesthesia, Faculty of medicine, Ain-Shams University, Cairo, Egypt.

Dalia Nasr El-Din, MD

Department of Anaesthesia, Faculty of medicine, Ain-Shams University, Cairo, Egypt.

Reem El-Kabarity, MD

Department of Anaesthesia, Faculty of medicine, Ain-Shams University, Cairo, Egypt.

Azia Atef, MD

Department of Anaesthesia, Faculty of medicine, Ain-Shams University, Cairo, Egypt.

Atef El-Fakey, MD

Department of Anaesthesia, Faculty of medicine, Ain-Shams University, Cairo, Egypt.


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How to Cite

Elhakim, MD, M., H. A. Elfattah, MD, D. N. El-Din, MD, R. El-Kabarity, MD, A. Atef, MD, and A. El-Fakey, MD. “Midazolam As an Antiemetic in Patients Receiving Epidural Morphine for Postoperative Pain Relief”. Journal of Opioid Management, vol. 5, no. 4, Jan. 2018, pp. 189-95, doi:10.5055/jom.2009.0020.