The effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia

Özalevli, M.; Çetin, Taha; Ünlügenç, H.; Güler, Tayfun; Işik, G.

doi:10.1097/00003643-200505001-00362

Cited by 34 publications

(56 citation statements)

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“…The two remaining trials were conducted on patients undergoing major abdominal surgery [40] and thoracotomy [41]. Attempts were made to contact eight authors because of incomplete data [13,14,28,30,31,36,38,41], but none provided the information requested.…”

Section: Resultsmentioning

confidence: 99%

“…There was significant variability between trials in anaesthetic regimens. For example, in the intrathecal space, magnesium was co-administered with levobupivacaine [26], hyperbaric bupivacaine [27,32,36], isobaric bupivacaine [29,30,34,38], lidocaine [37] or opioids without local anaesthetic [13,41]. Table 2 presents the acute pain-related endpoints.…”

Section: Resultsmentioning

confidence: 99%

“…The time to first analgesic request was increased by 11.1% following intrathecal administration of magnesium Regression time of sensory bockade Intrathecal 5 [27], [29], [36], [30], [32] Regression time of motor blockade Intrathecal 7 [27], [34], [29], [36], [30], [32] Time to first analgesic request after neuraxial blockade; min Intrathecal 6 [27], [34], [29], [36], [30], [ Table 2 Continued. [26], [27], [29], [41] Table 2 Continued.…”

Section: Resultsmentioning

confidence: 99%

“…[26], [27], [29], [41] Table 2 Continued. [26], [27], [34], [29], [36], [41], [30], [37], [13], [34], [29], [36], [41], [30], [38] (mean difference: 39.6 min; 95% CI: 16.30-63.0 min; p = 0.0009), and by 72.2% after epidural administration (mean difference: 109.5 min; 95% CI: 19.6-199.3 min; p = 0.02). Cumulative morphine consumption at 24 h postoperatively was 29.4% lower with intrathecal magnesium (mean difference: )6.0 mg; 95% CI: )10.4 to )1.6 mg; p = 0.008).…”

Section: Resultsmentioning

confidence: 99%

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The analgesic efficacy and safety of neuraxial magnesium sulphate: a quantitative review

et al. 2012

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SummaryEighteen published trials have examined the use of neuraxial magnesium as a peri-operative adjunctive analgesic since 2002, with encouraging results. However, concurrent animal studies have reported clinical and histological evidence of neurological complications with similar weight-adjusted doses. The objectives of this quantitative systematic review were to assess both the analgesic efficacy and the safety of neuraxial magnesium. Eighteen trials comparing magnesium with placebo were identified. The time to first analgesic request increased by 11.1% after intrathecal magnesium administration (mean difference: 39.6 min; 95% CI 16.3-63.0 min; p = 0.0009), and by 72.2% after epidural administration (mean difference: 109.5 min; 95% CI 19.6-199.3 min; p = 0.02) with doses of between 50 and 100 mg. Four trials monitored for neurological complications: of the 140 patients included, only a 4-day persistent headache was recorded. Despite promising peri-operative analgesic effect, the risk of neurological complications resulting from neuraxial magnesium has not yet been adequately defined. Magnesium has analgesic properties, primarily related to the regulation of calcium influx into cells [1] and antagonism of N-methyl-D-aspartate (NMDA) receptors in the central nervous system [2,3]. This analgesic effect was first demonstrated in humans in 1996 when magnesium was administered intravenously in the peri-operative period [4]. Since then, a number of additional trials investigating the analgesic efficacy of peri-operative intravenous magnesium have been published, with conflicting results [5][6][7]. One possible explanation for the reported variability in analgesic efficacy of magnesium administered intravenously may be limited passage of this molecule across the blood-brain barrier, which has been demonstrated even in the presence of induced systemic hypermagnesaemia [8][9][10]. Consequently, it has been suggested that an intrathecal injection would allow more effective magnesium activity at spinal cord NMDA receptors. Indeed, rat models reveal that direct intrathecal administration of magnesium enhances the antinociceptive effect of opioids for acute incisional pain [11], and suppresses nociceptive responses in neuropathic pain models [12]. The earliest clinical trials investigating intrathecal and epidural magnesium reported an increase in the median duration of analgesia [13] and decrease in opioid consumption by 25% [14], respectively.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

The analgesic efficacy and safety of neuraxial magnesium sulphate: a quantitative review

et al. 2012

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“…At resting membrane potential, NMDA receptor channels are blocked by extracellular magnesium ions in a non‐competitive manner [193]. Intrathecal magnesium 50 mg has been shown to prolong the analgesic effect of intrathecal fentanyl for labour analgesia [194] and lower limb surgery [195], although the latter study did demonstrate a slower onset of motor and sensory blockade with the use of magnesium. When used as adjunct to bupivacaine and sufentanil in patients undergoing lower limb arthroplasty, intrathecal magnesium 94.5 mg decreased postoperative analgesia requirements by almost 50% [196].…”

Section: Adjuvants To Local Anaestheticsmentioning

confidence: 99%

Local anaesthetics and adjuvants – future developments

Wiles¹,

Nathanson²

2010

Anaesthesia

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Summary The introduction of local anaesthesia some years after the first public demonstration of general anaesthesia not surprisingly created less excitement and interest amongst both the public and the medical profession. However, in its own way, a new revolution was happening. Local anaesthesia produced an increase in the choice of anaesthetic techniques available to practitioners and patients. In common with general anaesthesia, the choice of agents remained very limited for the first six decades, and interest in the practice of local, regional or central neuraxial blockade and the development of new techniques and drugs were hampered by perceived safety issues even as late as the second half of the 20th century. It is only in the last few years that, with an apparent renaissance in the use of local anaesthesia, the pace of development has picked up. As the use and range of techniques has increased, so has interest in solving some of the longstanding problems with the available drugs.

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Intrathecal dexmedetomidine versus magnesium sulphate for postoperative analgesia and stress response after caesarean delivery; randomized controlled double‐blind study

Mostafa

Herdan

Fathy

et al. 2019

European Journal of Pain

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Background Various adjuvants were added to intrathecal anaesthetics to improve quality of the block and postoperative analgesia. We hypothesized that intrathecal dexmedetomidine and magnesium sulphate (MgSO4) may add similar effects. Our objectives were to compare their effects as adjuvants to intrathecal bupivacaine on postoperative analgesia, stress hormones, sedative properties and the neonatal outcome after caesarean section. Methods A randomized double‐blind controlled study; 90 parturients were divided into three groups. All patients received intrathecal hyperbaric bupivacaine 12.5 mg. NaCl 0.9% was added to intrathecal block in group C, 5 μg dexmedetomidine in the group D and 50 mg MgSO4 in group M. Visual analogue scale (VAS) score, stress hormones were assessed within the first 12 postoperative hours, sensory block, and neonatal outcome were also assessed. Results VAS scores were significantly lower in groups D and M. Onset of postoperative pain was significantly prolonged in group D. Time to peak sensory level was shorter in group D. Sedation score was significantly higher in group D only after 30 min of intrathecal block. Although stress hormones increased in all groups during intraoperative and postoperative periods, their levels were significantly lower in group D compared to other groups. No differences were noted regarding neonatal outcomes. Conclusion Intrathecal dexmedetomidine is superior to intrathecal MgSO4 during caesarean section with regard to duration of analgesia, pain severity and stress hormone levels. Dexmedetomidine has a rapid onset and longer duration of sensory block compared to MgSO4. No significant adverse effects to the parturients or newborns.

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The effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia

Cited by 34 publications

References 0 publications

The analgesic efficacy and safety of neuraxial magnesium sulphate: a quantitative review

The analgesic efficacy and safety of neuraxial magnesium sulphate: a quantitative review

Local anaesthetics and adjuvants – future developments

Intrathecal dexmedetomidine versus magnesium sulphate for postoperative analgesia and stress response after caesarean delivery; randomized controlled double‐blind study

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