Comparative efficacy of ropivacaine and levobupivacaine in combined femoral and lateral femoral cutaneous nerve block with adjuvant magnesium for post-operative analgesia

Abstract

Background and Aims:Patients with burns may require multiple surgeries, but poor general condition and underlying protein energy malnutrition make them unsuitable candidates for general or spinal anaesthesia. This study evaluated the role of magnesium sulphate as an adjuvant with levobupivacaine and ropivacaine used in combined femoral and lateral femoral cutaneous nerve (LFCN) blocks in burn patients with relative sparing of thigh portion.Methods:This prospective, randomised, double-blind study included 54 adult patients of 18–65 years age, undergoing split-thickness skin graft harvest from the thigh, allotted to three equal groups of 18 each. Group L patients received femoral nerve (FN) block with 15 mL of 0.5% levobupivacaine and 8 mL for LFCN block; Group LM patients received 14 mL of 0.5% levobupivacaine along with 1.0 mL of 15% magnesium sulphate for FN block, 7.5 mL of 0.5% levobupivacaine with 0.5 mL of 15% of magnesium sulphate to LFCN block and Group R patients received 15 mL of 0.5% ropivacaine for FN block and 8 mL of 0.5% ropivacaine for LFCN block. Time to block onset and complete surgical block, duration of analgesia, total analgesic dose and the overall analgesia satisfaction score were measured in the first 24 h post-operatively. Quantitative data were analysed with ANOVA and qualitative data subjected to Chi-square tests. Intergroup comparison was performed with independent t-test.Results:The duration of post-operative analgesia did not differ with the addition of magnesium (P = 0.610). Time to onset of the block was significantly decreased with the addition of magnesium (P = 0.0341), but time to complete surgical block onset was similar across the groups.Conclusion:Both ropivacaine and levobupivacaine have good perioperative analgesic efficacy. Magnesium as an analgesia adjuvant with levobupivacaine does not prolong the duration of post-operative analgesia.

The Use of Magnesium Sulfate and Peripheral Nerve Blocks

“…Our literature search identified 578 studies, including 21 eligible RCTs and 1323 patients that met the study inclusion criteria (Table 1). [5][6][7][8][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] In total, 557 studies were rejected for the following reasons: 537 were not RCTs, 7 were reviews, 4 included animal experiments, 2 lacked a control group, and 7 investigated local anesthesia without nerve block. Table 1 summarizes all relevant patient characteristics and specific treatment methods.…”

“…Table 1 summarizes all relevant patient characteristics and specific treatment methods. Eight studies [5][6][7]15,19,[25][26][27] assessed the role of magnesium sulfate as an adjuvant in brachial plexus blockade, 6 [12][13][14]16,17,24 in femoral or sciatic nerve blockade, 4 11,18,21,22 in TAP block, and 3 8,20,23 assessed its role in thoracic or intercostal nerve blockade.…”

The Impact of Adding Magnesium Sulfate to Bupivacaine versus Bupivacaine Alone in Fascia Iliaca Compartment Block in Burn Patients Undergoing Skin Grafting Procedures; Comparative Study

“…Skin graft donor sites are usually chosen from the lateral and/or anterior upper part of the thigh. These areas coincide with the distribution of the lateral femoral cutaneous nerve (LFCN) and femoral nerve [3]. The fascia iliaca compartment block (FICB) is effective in producing the simultaneous blockade of both LFCN and femoral nerve [4].…”

Comparison of ropivacaine with magnesium sulphate and plain ropivacaine in ultrasound guided supraclavicular blocks for upper limb surgeries

“…Hence in the modern era of medicine perineural adjuvant came into picture to enhance the earlier onset action and prolongedefficacy. Magnesium sulphate by the virtue of NMDA receptors antagonist property 2 has been established as an adjuvant to local anesthetics inneuraxial blocks, peripheral nerve blocks 3 and transverses abdominal blocks. 4 It can also be used as an adjuvant in supraclavicular blockswith good encouraging results; still its consensus to be attained.…”