To evaluate the efficacy of intrathecal magnesium sulphate for hysterectomy under subarachnoid block with bupivacaine and fentanyl: A prospective randomized double blind clinical trial

Mridu Paban Nath, Rakesh Garg, Tapan Talukdar, Dipika Choudhary, Anulekha Chakrabarty, Mridu Paban Nath, Rakesh Garg, Tapan Talukdar, Dipika Choudhary, Anulekha Chakrabarty

Abstract

Background: Intrathecal magnesium has been found to prolong the duration of analgesia in various surgical procedures like lower limb surgeries and as adjuncts to general anesthesia for pain management. The present study was designed to examine whether addition of intrathecal magnesium sulfate would enhance the analgesic efficacy of intrathecal bupivacaine and fentanyl in patients undergoing total abdominal hysterectomy.

Methods: After taking informed consent, 60 patients were randomised into two groups with 30 patients. Group "S" received 2.5 mL (12.5 mg) of hyperbaric bupivacaine + 0.5 mL (25 mcg) of fentanyl + 0.5 mL of normal saline and Group "M" received 2.5 mL (12.5 mg) of hyperbaric bupivacaine + 0.5 mL (25 mcg) of fentanyl + 0.5 mL (100 mg) of magnesium sulfate. Onset of sensory, motor block and duration of analgesia was noted.

Results: Demographic profile and duration of surgery were comparable (P>0.5). Time of onset of sensory and motor blockade was delayed in Group M compared with Group S, and this was statistically significant. A statistically significant longer duration of analgesia was observed in Group M compared with the control Group S. However, the recovery of motor blockade was found to be statistically insignificant in both the groups. The hemodynamic parameters were comparable in the perioperative period (P>0.05). The incidence of side-effects in both the groups were also comparable (P>0.05).

Conclusion: The addition of 100 mg intrathecal magnesium led to prolonged duration of analgesia significantly without increasing the incidence of side-effects. Also, there was a significant delay in the onset of both sensory and motor blockade.

Keywords: Abdominal hysterectomy; analgesia; magnesium sulfate; subarachnoid block.

Conflict of interest statement

Conflict of Interest: None declared.

References

    1. Woolf CJ, Thompson SW. The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation: Implications for the treatment of post-injury pain and hypersensitivity states. Pain. 1991;44:293–9.
    1. Woolf CJ, Chong MS. Preemptive analgesia: Treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993;77:362–79.
    1. Ascher P, Nowak L. Electrophysiological studies of NMDA receptors. Trends Neurosci. 1987;10:284–8.
    1. Ko SH, Lim HR, Kim DC, Han YJ, Choe H, Song HS. Magnesium sulphate does not reduce postoperative analgesic requirements. Anesthesiology. 2001;95:640–6.
    1. Mebazaa MS, Ouerghi S, Frikha N, Moncer N, Mestiri K, James MF, et al. Is magnesium sulfate by the intrathecal route efficient and safe? Ann Fr Anesth Reanim. 2011;30:47–50.
    1. Wilder-Smith CH, Knopfli R, Wilder-Smith OH. Perioperative magnesium infusion and postoperative pain. Acta Anaesthesiol Scand. 1997;41:1023–7.
    1. Thuranu GR, Kemp DB, Jarvis A. Cerebrospinal fluid levels of magnesium in patients with preeclampsia after treatment with intravenous magnesium sulfate: A preliminary report. Am J Obstet Gynecol. 1987;157:1435–8.
    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. Ozalevli M, Cetin TO, Unlugence H, Guler T, Isik G. The effect of adding intrathecal magnesium sulphate to bupivacaine fentanyl spinal anaesthesia. Acta Anaesthesiol Scand. 2005;49:1514–9.
    1. Lee JW, Kim MK, Shin YS, Koo BN. The analgesic effect of single dose of intrathecal magnesium sulfate. Korean J Anesthesiol. 2007;52:72–6.
    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 postoperative analgesic requirements. Acta Anaesthesiol Scand. 2007;51:482–9.
    1. Bohannon TW, Estes MD. Evaluation of subarachnoid fentanyl for postoperative analgesia (Abstract) Anesthesiology. 1987;67:237.
    1. Biswas BN, Rudra A, Bose BK, Nath S, Chakrabarty S, Bhattacharjee S. Intrathecal fentanyl with hyperbaric bupivacaine improves analgesia during caesarean delivery and in early postoperative period. Indian J Anaesth. 2002;66:469–72.
    1. Singh V, Gupta LK, Singh GP. Comparison among intrathecal fentanyl and butorphanol in combination with bupivacaine for lower limb surgeries. J Anaesth Clin Pharmacol. 2006;22:371–5.
    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. Unlugenc H, Ozalevli M, Gunduz M, Gunasti S, Urunsak IF, Guler T, et al. Comparison of intrathecal magnesium, fentanyl, or placebo combined with bupivacaine 0.5% for parturients undergoing elective cesarean delivery. Acta Anaesthesiol Scand. 2009;53:346–53.
    1. Malleeswaran S, Panda N, Mathew P, Bagga R. A randomised study of magnesium sulphate as an adjuvant to intrathecal bupivacaine in patients with mild preeclampsia undergoing caesarean section. Int J Obstet Anesth. 2010;19:161–6.
    1. Breen TW, Shapiro T, Glass B, Foster-Payne D, Oriol NE. Epidural anesthesia for labor in the ambulatory patient. Anesth Analg. 1993;77:919–24.
    1. Schulte-Tamburen AM, Scheier J, Briegel J, Schwender D, Peter K. Comparison of five sedation scoring systems by means of auditory evoked potentials. Intensive Care Med. 1999;25:377–82.
    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 Reanim. 2009;28:454–9.
    1. Okutomi T, Saito M, Matsumoto Y, Shimizu M, Fukuoka M, Hoka S. Altered bupivacaine pharmacokinetics by MgSO4 in rats. Can J Anaesth. 2004;51:93–4.
    1. Hung YC, Chen CY, Lirk P, Wang CF, Cheng JK, Chen CC, et al. Magnesium sulfate diminishes the effects of amide local anesthetics in rat sciatic-nerve block. Reg Anesth Pain Med. 2007;32:288–95.
    1. Witlin AG, Sibai BM. Magnesium sulfate therapy in preeclampsia and eclampsia. Obstet Gynecol. 1998;92:883–9.

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