Magnesium sulfate versus Lidocaine pretreatment for prevention of pain on etomidate injection: A randomized, double-blinded placebo controlled trial

Abstract

Objective:Etomidate is an imidazole derivative and formulated in 35% propylene glycol. When given without a rapid lidocaine injection, etomidate is associated with pain after injection. Magnesium (Mg) is a calcium channel blocker and influences the N-methyl-D-aspartate receptor ion channel. The aim of the study is to evaluate the efficiency of preemptive injection of magnesium sulfate and lidocaine on pain alleviation on etomidate intravenous injection.Methods:In a randomized, double-blinded trial study, 135 adult patients scheduled for elective outpatient or inpatient surgery were divided into three groups. Group M received 620 mg magnesium sulfate, Group L received 3 ml lidocaine 1% and Group S received normal saline, all in a volume of 5 mL followed by a maximal dose of 0.3 mg/kg of 1% etomidate. Pain was assessed on a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain and 3 = severe pain at the time of pretreatment and etomidate injection.Findings:About 60% of patients in the control group had pain during etomidate injection as compared to 22.2% and 40% in the lidocaine and magnesium sulfate groups, respectively. There was difference in induction pain score between three treatment groups, significantly (P = 0.01) and observed differences in pain scores between “normal saline and lidocaine group” (P < 0.001) and “normal saline and magnesium sulfate groups” were statistically meaningful (P = 0.044).Conclusion:Intravenous magnesium sulfate and lidocaine injection are comparably effective in reducing etomidate-induced pain.

Use Profile of Magnesium Sulfate in Anesthesia in Brazil

“…All the clinical effects for the use of magnesium sulfate in anesthesia presented by the anesthesiologists participating in this survey have been reported in other publications, including various systematic reviews and meta-analyses, although some of them are still subjects of controversy Beşogul et al, 2009; Gozdemir et al, 2010; Rhee et al, 2012; Abdulatif et al, 2013; Rotava et al, 2013; Agrawal et al, 2014; Ahsan et al, 2014; Crowther et al, 2014; Kahraman and Eroglu, 2014; Kew et al, 2014; Marzban et al, 2014; Rodrigo et al, 2014; Srebro et al, 2014; Uludag et al, 2014; Berhan and Berhan, 2015; Kim et al, 2015; Safavi et al, 2015; Vigil-De Gracia and Ludmir, 2015; Demiroglu et al, 2016; Green, 2016; Griffiths and Kew, 2016; Jangra et al, 2016; Juibari et al, 2016; Maged et al, 2016; Naghipour et al, 2016; Rodríguez-Rubio et al, 2016, 2017; Soltani et al, 2016; Thomas and Behr, 2016; Ulm et al, 2016; Vendrell et al, 2016; Xie et al, 2016, 2017; Brookfield et al, 2017; Haryalchi et al, 2017; Kutlesic et al, 2017; Lecuyer et al, 2017; McKeown et al, 2017; Mendonca et al, 2017; Salaminia et al, 2018; Zhang et al, 2018.…”

Comparison of the Effects of Low-Dose Midazolam, Magnesium Sulfate, Remifentanil and Low-Dose Etomidate on Prevention of Etomidate-Induced Myoclonus in Orthopedic Surgeries

“…A variety of drugs are known that reduce myoclonus due to etomidate to different extends such as dexmedetomidine ( 1 ), opioids ( 4 , 6 , 18 , 22 - 24 ) benzodiazepines ( 25 - 27 ), lidocaine ( 5 , 28 ), magnesium sulfate ( 5 , 21 , 29 ), muscle relaxants ( 17 , 30 ), gabapentin ( 14 ) thiopental ( 31 ) and dezocine ( 32 ). However, offending drugs should be strictly limited to accurate indications.…”