Adding different doses of intrathecal magnesium sulfate for spinal anesthesia in the cesarean section: A prospective double blind randomized trial

Mitra Jabalameli, Seyed Hamid Pakzadmoghadam, Mitra Jabalameli, Seyed Hamid Pakzadmoghadam

Abstract

Background: There is uncertainty as to whether addition of magnesium sulfate to spinal local anesthetics improves quality and duration of block in the caesarean section. In this randomized double blind clinical trial study, we investigated the effect of adding different doses of intrathecal magnesium sulfate to bupivacaine in the caesarean section.

Materials and methods: After institutional approval and obtaining informed patient consent, 132 ASA physical status I-II women undergoing elective cesarean section with spinal anesthesia were randomized to four groups: 1 - 2.5 cc Bupivacaine 0.5%+ 0.2 cc normal saline (group C) 2 - 2.5 cc Bupivacaine 0.5%+ 0.1 cc normal saline+ 0.1 cc magnesium sulfate 50% (group M(50)) 3- 2.5 cc Bupivacaine 0.5%+ 0.05 cc normal saline+ 0.15 cc magnesium sulfate 50% (group M(75)) 4- 2.5 cc Bupivacaine 0.5%+ 0.2 cc magnesium sulfate 50% (group M(100)). Patients and staff involved in data collections were unaware of the patient group assignment. We recorded the following: onset and duration of block, time to complete motor block recovery, and analgesic requirement.

Results: Magnesium sulfate caused a delay in the onset of both sensory and motor blockade. The duration of sensory and motor block were longer in M(75) and M(100) groups than group C (P < 0.001). Recovery time was shorter in group C (P < 0.001) and analgesic requirement was more in group C than others (P < 0.001).

Conclusions: In patients undergoing the caesarean section under hyperbaric bupivacaine spinal anesthesia, the addition of 50, 75, or 100 mg magnesium sulfate provides safe and effective anesthesia, but 75 mg of this drug was enough to lead a significant delay in the onset of both sensory and motor blockade, and prolonged the duration of sensory and motor blockade, without increasing major side effects.

Keywords: ASA; bupivacaine; caesarean section magnesium sulfate; local anesthetics; spinal anesthesia.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Flow diagram of enrolled study patients. There was no significant difference among the groups with respect to patient characteristics, age, height, weight, gestational age, and duration of surgery

References

    1. Yousef AA, Amr YM. The effect of adding magnesium sulphate to epidural bupivacaine and fentanyl in elective Cesarean Section using combined spinal-epidural anesthesia: A prospective double blind randomized study. Int J Obstet Anesth. 2010;19:401–4.
    1. Ashburn MA, Love G, Pace NL. Respiratory-related critical events with intravenous patient-controlled analgesia. Clin J Pain. 1994;10:52–6.
    1. Dayioglu H, Baykara ZN, Salbes A, Solak M, Toker K. Effects of adding magnesium to bupivacaine and fentanyl for spinal anesthesia in knee arthroscopy. J Anesth. 2009;23:19–25.
    1. Ascher P, Nowak L. Electrophysiological studies of NMDA receptors. Trends Neurosci. 1987;10:284–8.
    1. Xiao WH, Bennet GJ. magnesium suppresses neuropathic pain responses in rat via a spinal site of action. Brain Res. 1994;666:168–72.
    1. Tramer MR, Schneider J, Marti RA, Rifat K. Role of magnesium sulfate in postoperative analgesia. Anesthesiology. 1996;84:340–7.
    1. Katz J, Kavanagh BP, Sandler AN, Nierenberg H, Boylan JF, Friedlander M, et al. Preemetive analgesia: Clinical evidence of neuroplasticity contributing to postoperative pain. Anesthesiology. 1992;77:439–46.
    1. Kroin JS, McCarthy RJ, Von Roenn N, Schwab B, Tuman KJ, Ivankovich AD. Magnesium sulfate potentiates morphine antinociception at the spinal level. Anesth Analg. 2000;90:913–7.
    1. Buvanendran A, McCarthy RJ, Kroin JS, Leong W, Perry P, Tuman KJ. Intrathecal magnesium prolongs fentanyl analgesia: A prospective, randomized, controlled trial. Anesth Analg. 2002;95:661–6.
    1. Khalili G, Janghorbani M, Sajedi P, Ahmadi G. Effects of adjunct intrathecal magnesium sulfate to bupivacaine for spinal anesthesia: A randomized double-blind trial in patients undergoing lower extremity surgery. J Anesth. 2011;25:892–7.
    1. Ghrab BE, Maatoug M, Kallel N, Khemakhem K, Chaari M, Kolsi K, et al. Does Combination of intrathecal magnesium sulfate and morphine improve postcaesarean section analgesia? Ann Fr Anesth Rean. 2009;28:454–9.
    1. Arcioni R, Palmisani S, Tigano S, Santorsola C, Sauli V, Romanò S, et al. Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post-operative analgesic requirements: A prospective, randomized, double-blinded controlled trial in patients with undergoing major orthopedic surgery. Acta Anesthesiol Scand. 2007;51:482–9.
    1. Lejuste MJ. Inadvertent intrathecal administration of magnesium sulfate. S Afr Med J. 1985;68:367–8.
    1. Dickenson AH. NMDA receptor antagonists: Interaction with opioids. Acta Anaesthesiol Scand. 1997;41:112–5.
    1. Ozalevli M, Cetin TO, Unlugence H. The effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anesthesia. Acta Anaesthesiol Scan. 2005;49:1514–9.
    1. Simpson JI, Eide TR, Schiff GA, Clagnaz JF, Hossain I, Tverskoy A, et al. Intrathecal magnesium sulfate protects the spinal cord from ischemic injury during thoracic aortic cross clamping. Anesthesiology. 1994;81:1493–9.
    1. Karaman S, Kocaba M. The Effective of sufentanil or morphine added to hyperbaric bupivacaine in spinal anesthesia for caesarean section. European Journal of Anesthesia. 2006;23:285–91.
    1. Witlin AG, Sibai BM. Magnesium sulfate therapy in preeclampsia and eclampsia. Obstet Gynecol. 1998;92:883–9.
    1. McCarthy RJ, Kroin JS, Tuman KJ, Penn RD, Ivankovich AD. Antinociceptive potentiation and attenuation of tolerance by intrathecal co-infusion of magnesium sulfate and morphine in rats. Anesth Analg. 1998;86:830–6.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner