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Lewis SA, Shetty S, Gamble S, Heim J, Zhao N, Stitt G, Pankratz M, Mangum T, Marku I, Rosenberg RB, Wilfong AA, Fahey MC, Kim S, Myers SJ, Appavu B, Kruer MC. Intrathecal magnesium delivery for Mg++-insensitive NMDA receptor activity due to GRIN1 mutation. Orphanet J Rare Dis 2023; 18:225. [PMID: 37537625 PMCID: PMC10398931 DOI: 10.1186/s13023-023-02756-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 06/04/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Mutations in the NMDA receptor are known to disrupt glutamatergic signaling crucial for early neurodevelopment, often leading to severe global developmental delay/intellectual disability, epileptic encephalopathy, and cerebral palsy phenotypes. Both seizures and movement disorders can be highly treatment-refractory. RESULTS We describe a targeted ABA n-of-1 treatment trial with intrathecal MgSO4, rationally designed based on the electrophysiologic properties of this gain of function mutation in the GRIN1 NMDA subunit. CONCLUSION Although the invasive nature of the trial necessitated a short-term, non-randomized, unblinded intervention, quantitative longitudinal neurophysiologic monitoring indicated benefit, providing class II evidence in support of intrathecal MgSO4 for select forms of GRIN disorders.
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Affiliation(s)
- Sara A Lewis
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, 85016, USA
- Departments of Child Health, Neurology, Cellular & Molecular Medicine, and Program in Genetics, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Sheetal Shetty
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, 85016, USA
- Departments of Child Health, Neurology, Cellular & Molecular Medicine, and Program in Genetics, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Sean Gamble
- Valley Anesthesia, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Jennifer Heim
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, 85016, USA
| | - Ningning Zhao
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
| | - Gideon Stitt
- Department of Pharmacy & Therapeutics, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Matthew Pankratz
- Phoenix Children's Hospital Biorepository, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Tara Mangum
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, 85016, USA
| | - Iris Marku
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, 85016, USA
| | - Robert B Rosenberg
- Division of Pediatric Critical Care Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Angus A Wilfong
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, 85016, USA
| | - Michael C Fahey
- Departments of Paediatrics and Neurology, Monash University, Melbourne, VIC, Australia
| | - Sukhan Kim
- Center for Functional Evaluation of Rare Variants, Emory University, Atlanta, GA, USA
| | - Scott J Myers
- Center for Functional Evaluation of Rare Variants, Emory University, Atlanta, GA, USA
| | - Brian Appavu
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, 85016, USA
| | - Michael C Kruer
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, 85016, USA.
- Departments of Child Health, Neurology, Cellular & Molecular Medicine, and Program in Genetics, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.
- Programs in Neuroscience, Molecular & Cellular Biology, and Biomedical Informatics, Arizona State University, Tempe, AZ, USA.
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Patel S. Epidural and intrathecal magnesium sulphate administration errors: clinical features and contributing factors. Br J Anaesth 2023; 130:e435-e440. [PMID: 36702653 DOI: 10.1016/j.bja.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/27/2022] [Accepted: 12/19/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Santosh Patel
- Department of Anaesthesia, Tawam Hospital, Al Ain, United Arab Emirates.
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Pomary PK, Eichau S, Amigó N, Barrios L, Matesanz F, García-Valdecasas M, Hrom I, García Sánchez MI, Garcia-Martin ML. Multifaceted Analysis of Cerebrospinal Fluid and Serum from Progressive Multiple Sclerosis Patients: Potential Role of Vitamin C and Metal Ion Imbalance in the Divergence of Primary Progressive Multiple Sclerosis and Secondary Progressive Multiple Sclerosis. J Proteome Res 2023; 22:743-757. [PMID: 36720471 PMCID: PMC9990127 DOI: 10.1021/acs.jproteome.2c00460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The progressive forms of multiple sclerosis (MS) primary progressive MS (PPMS) and secondary progressive MS (SPMS) are clinically distinguished by the rate at which symptoms worsen. Little is however known about the pathological mechanisms underlying the differential rate of accumulation of pathological changes. In this study, 1H NMR spectroscopy was used to measure low-molecular-weight metabolites in paired cerebrospinal fluid (CSF) and serum of PPMS, SPMS, and control patients, as well as to determine lipoproteins and glycoproteins in serum samples. Additionally, neurodegenerative and inflammatory markers, neurofilament light (NFL) and chitinase-3-like protein 1 (CHI3L1), and the concentration of seven metal elements, Mg, Mn, Cu, Fe, Pb, Zn, and Ca, were also determined in both CSF and serum. The results indicate that the pathological changes associated with progressive MS are mainly localized in the central nervous system (CNS). More so, PPMS and SPMS patients with comparable disability status are pathologically similar in relation to neurodegeneration, neuroinflammation, and some metabolites that distinguish them from controls. However, the rapid progression of PPMS from the onset may be driven by a combination of neurotoxicity induced by heavy metals coupled with diminished CNS antioxidative capacity associated with differential intrathecal ascorbate retention and imbalance of Mg and Cu.
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Affiliation(s)
- Precious Kwadzo Pomary
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, C/Severo Ochoa, 35, 29590 Málaga, Spain
| | - Sara Eichau
- Unidad de Neurología, Hospital Universitario Virgen de la Macarena, Av. Dr. Fedriani, 3, 41009 Sevilla, Spain
| | - Núria Amigó
- Biosfer Teslab, 43201 Reus, Spain.,Department of Basic Medical Sciences, University Rovira I Virgili, IISPV, CIBERDEM, 43201 Reus, Spain
| | - Laura Barrios
- Statistics Department, Computing Center (SGAI-CSIC), Pinar 19, Madrid 28006, Spain
| | - Fuencisla Matesanz
- Instituto de Parasitologia y Biomedicina ″Lopez-Neyra″, Avda. del Conocimiento 17. P. T. Ciencias de la Salud, 18016 Granada, Spain
| | - Marta García-Valdecasas
- Unidad de Neurología, Hospital Universitario Virgen de la Macarena, Av. Dr. Fedriani, 3, 41009 Sevilla, Spain
| | - Ioana Hrom
- Unidad de Neurología, Hospital Universitario Virgen de la Macarena, Av. Dr. Fedriani, 3, 41009 Sevilla, Spain
| | - María Isabel García Sánchez
- Unidad de Neurología, Hospital Universitario Virgen de la Macarena, Av. Dr. Fedriani, 3, 41009 Sevilla, Spain
| | - Maria Luisa Garcia-Martin
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, C/Severo Ochoa, 35, 29590 Málaga, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials & Nanomedicine (CIBER-BBN), 29590 Málaga, Spain
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4
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El-Khodor BF, James K, Chang Q, Zhang W, Loiselle YR, Panda C, Hanania T. Elevation of brain magnesium with Swiss chard and buckwheat extracts in an animal model of reduced magnesium dietary intake. Nutr Neurosci 2021; 25:2638-2649. [PMID: 34730480 DOI: 10.1080/1028415x.2021.1995119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Inadequate dietary magnesium (Mg) intake is a growing public health concern. Mg is critical for diverse metabolic processes including energy production, macromolecule biosynthesis, and electrolyte homeostasis. Inadequate free Mg2+ ion concentration ([Mg2+]) in the brain is associated with several neurological and behavioral disorders. Elevating [Mg2+]in the brain using oral Mg supplementation has proven to be challenging due to the tight regulation of Mg2+ transport to the brain. This study explored the effect of short-term moderate reduction in dietary Mg intake (87% of normal Mg diet for 30 days) on [Mg2+] in the cerebrospinal fluid (CSF) ([Mg2+]CSF) and red blood cells (RBCs) ([Mg2+]RBC) in adult male rats. In addition, we investigated the effectiveness of magnesium-rich blend of Swiss chard and buckwheat extracts (SC/BW extract) in increasing brain [Mg2+] compared to various Mg salts commonly used as dietary supplements. METHODS Animals were assigned to either normal or low Mg diet for 30 - 45 days. Following this, animals maintained on low Mg diet were supplemented with various Mg compounds. [Mg2+]CSF and [Mg2+]RBC were measured at baseline and following Mg administration. Anxiety-like behavior and cognitive function were also evaluated. RESULTS The present study showed that a short-term and moderate reduction in Mg dietary intake results in a significant decline in [Mg2+]CSF and [Mg2+]RBC and the emergence of anxiety-like behavior in comparison to animals maintained on normal Mg diet. Supplementation with SC/BW extract significantly elevated [Mg2+]CSF and improved animal performance in the novel object recognition test in comparison with animals maintained on reduced Mg intake and supplemented with various Mg compounds. DISCUSSION These observations indicate that brain [Mg2+] is more sensitive to a short-term and moderate reduction in Mg dietary intake than previously thought and emphasizes the importance of dietary Mg in replenishing brain Mg2+ reserves.
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Affiliation(s)
| | - Karma James
- Nutrition Innovation Center, Standard Process Inc., Kannapolis, NC, USA
| | | | - Wei Zhang
- Nutrition Innovation Center, Standard Process Inc., Kannapolis, NC, USA
| | - Yvette R Loiselle
- Nutrition Innovation Center, Standard Process Inc., Kannapolis, NC, USA
| | - Chinmayee Panda
- Nutrition Innovation Center, Standard Process Inc., Kannapolis, NC, USA
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5
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Zoratto D, Phelan R, Hopman WM, Wood GCA, Shyam V, DuMerton D, Shelley J, McQuaide S, Kanee L, Ho AMH, McMullen M, Armstrong M, Mizubuti GB. Adductor canal block with or without added magnesium sulfate following total knee arthroplasty: a multi-arm randomized controlled trial. Can J Anaesth 2021; 68:1028-1037. [PMID: 34041719 DOI: 10.1007/s12630-021-01985-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Postoperative analgesia following total knee arthroplasty (TKA) often includes intrathecal opioids, periarticular injection (PAI) of local anesthetic, systemic multimodal analgesia, and/or peripheral nerve blockade. The adductor canal block (ACB) provides analgesia without muscle weakness and magnesium sulphate (MgSO4) may extend its duration. The purpose of this trial was to compare the duration and quality of early post-TKA analgesia in patients receiving postoperative ACB (± MgSO4) in addition to standard care. METHODS Elective TKA patients were randomized to: 1) sham ACB, 2) ropivacaine ACB, or 3) ropivacaine ACB with added MgSO4. All received spinal anesthesia with intrathecal morphine, intraoperative PAI, and multimodal systemic analgesia. Patients and assessors remained blinded to allocation. Anesthesiologists knew whether patients had received sham or ACB but were blinded to MgSO4. The primary outcome was time to first analgesic (via patient-controlled analgesia [PCA] with iv morphine) following ACB. Secondary outcomes were morphine consumption, side effects, visual analogue scale pain scores, satisfaction until 24 hr postoperatively, and length of stay. RESULTS Of 130 patients, 121 were included. Nine were excluded post randomization: four were protocol violations, three did not meet inclusion criteria, and two had severe pain requiring open label blockade. There were no differences in the median [interquartile range] time to first PCA request: sham, 310 min [165-550]; ropivacaine ACB, 298 min [120-776]; and ropivacaine ACB with MgSO4, 270 min [113-780] (P = 0.96). Similarly, we detected no differences in resting pain, opioid consumption, length of stay, or associated side effects until 24 hr postoperatively. CONCLUSION We found no analgesic benefit of a postoperative ACB, with or without added MgSO4, in TKA patients undergoing spinal anesthesia and receiving intrathecal morphine, an intraoperative PAI, and multimodal systemic analgesia. TRIAL REGISTRATION www.clinicaltrials.gov (NCT02581683); registered 21 October 2015.
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Affiliation(s)
- Dana Zoratto
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Victory 2 Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Rachel Phelan
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Victory 2 Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Wilma M Hopman
- Kingston General Hospital Research Institute, Kingston Health Sciences Centre, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Gavin C A Wood
- Department of Surgery, Division of Orthopedic Surgery, Queen's University, Kingston, ON, Canada
| | - Vidur Shyam
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Victory 2 Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Deborah DuMerton
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Victory 2 Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Jessica Shelley
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Victory 2 Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Sheila McQuaide
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Victory 2 Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Lauren Kanee
- University of Toronto School of Medicine, Toronto, ON, Canada
| | - Anthony M-H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Victory 2 Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
| | - Michael McMullen
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Victory 2 Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Mitch Armstrong
- Department of Surgery, Division of Orthopedic Surgery, Queen's University, Kingston, ON, Canada
| | - Glenio B Mizubuti
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Victory 2 Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
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Postmortem Vitreous Humor Magnesium Does Not Elevate in Salt Water Drowning When the Immersion Time Is Less Than an Hour. ACTA ACUST UNITED AC 2017; 38:298-303. [DOI: 10.1097/paf.0000000000000351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Xiao F, Xu W, Feng Y, Fu F, Zhang X, Zhang Y, Wang L, Chen X. Intrathecal magnesium sulfate does not reduce the ED 50 of intrathecal hyperbaric bupivacaine for cesarean delivery in healthy parturients: a prospective, double blinded, randomized dose-response trial using the sequential allocation method. BMC Anesthesiol 2017; 17:8. [PMID: 28095795 PMCID: PMC5240204 DOI: 10.1186/s12871-017-0300-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 01/02/2017] [Indexed: 01/27/2023] Open
Abstract
Background Addition of intrathecal magnesium sulfate to local anesthetics has been reported to potentiate spinal anesthesia and prolong analgesia in parturients. The current study was to determine whether intrathecal magnesium sulfate would reduce the dose of hyperbaric bupivacaine in spinal anesthesia with bupivacaine and sufentanil for cesarean delivery. Methods Sixty healthy parturients undergoing scheduled cesarean delivery were randomly assigned to receive spinal anesthesia with 0.5% hyperbaric bupivacaine and 5 μg sufentanil with either 0.9% sodium chloride (Control group) or 50% magnesium sulfate (50 mg) (Magnesium group). Effective anesthesia was defined as a bilateral T5 sensory block level achieved within 10 min of intrathecal drug administration and no additional epidural anesthetic was required during surgery. Characteristic of spinal anesthesia and the incidence of side effects were observed. The ED50 for both groups was calculated using the Dixon and Massey formula. Results There was no significant difference in the ED50 of bupivacaine between the Magnesium group and the Control group (4.9 mg vs 4.7 mg) (P = 0.53). The duration of spinal anesthesia (183 min vs 148 min, P < 0.001) was longer, the consumption of fentanyl during the first 24 h postoperatively (343 μg vs 550 μg, P < 0.001) was lower in the Magnesium group than that in the Control group. Conclusions Intrathecal magnesium sulfate (50 mg) did not reduce the dose requirement of intrathecal bupivacaine, but can extend the duration of spinal anesthesia with no obvious additional side effects. Trial registration This study was registered with Chinese Clinical Trial Registry (ChiCTR) on 15 Jul. 2014 and was given a trial ID number ChiCTR-TRC-14004954.
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Affiliation(s)
- Fei Xiao
- Department of Anesthesia, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Anesthesia, Jiaxing Maternity and Child Care Hospital, Jiaxing, Zhejiang, China
| | - Wenping Xu
- Department of Anesthesia, Jiaxing Maternity and Child Care Hospital, Jiaxing, Zhejiang, China
| | - Ying Feng
- Department of Anesthesia, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Feng Fu
- Department of Anesthesia, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaomin Zhang
- Department of Anesthesia, Jiaxing Maternity and Child Care Hospital, Jiaxing, Zhejiang, China
| | - Yinfa Zhang
- Department of Anesthesia, Jiaxing Maternity and Child Care Hospital, Jiaxing, Zhejiang, China
| | - Lizhong Wang
- Department of Anesthesia, Jiaxing Maternity and Child Care Hospital, Jiaxing, Zhejiang, China
| | - Xinzhong Chen
- Department of Anesthesia, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Xu X, Wen H, Hu Y, Liu Z, Pan X. Efficacy of intra-articular magnesium for postoperative analgesia in total hip arthroplasty. Biomed Rep 2017; 6:232-236. [PMID: 28357078 DOI: 10.3892/br.2017.837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/17/2016] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to compare the efficacy of intra-articular magnesium sulphate and a saline placebo for postoperative pain control following total hip arthroplasty (THA). Sixty patients underwent THA and were randomly allocated into two groups to receive intra-articular injections of either 10 ml magnesium sulphate (100 mg/ml; magnesium group, n=30) or 10 ml normal saline solution (control group, n=30). Postoperative analgesia was maintained by intravenous morphine injection. The outcome measurements were visual analogue score (VAS), morphine consumption and Harris hip score (HHS). The two groups were well matched. The outcome of VAS at rest was significantly lower at postoperative hours 6 and 12 in the magnesium group as compared with the control group, although the difference was insignificant preoperatively and at postoperative hours 2, 4, 24 and 48, and days 3, 7 and 14. This indicator during activity was also lower in the magnesium group at postoperative hour 24 than that of the control group, although the difference was insignificant preoperatively and at hour 48, and days 7 and 14. The consumption of morphine (the total quantity) at 0-6, 6-12 and 0-48 h in the magnesium group was significantly lower than in the control group, although no significant differences were observed at 12-24 and 24-48 h between the groups. The improvements of HHS from preoperative to postoperative scores were statistically significant, however, no significant differences were identified between groups. Thus, the findings indicate that intra-articular magnesium sulphate injections provided improved pain control and reduced the need for morphine when compared with a saline placebo following THA.
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Affiliation(s)
- Xinxian Xu
- Department of Osteopathy, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Hong Wen
- Department of Osteopathy, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yuezheng Hu
- Department of Osteopathy, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Zhongtang Liu
- Department of Osteopathy, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Xiaoyun Pan
- Department of Osteopathy, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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Potential strategies for preventing chronic postoperative pain: a practical approach: Continuing Professional Development. Can J Anaesth 2015; 62:1329-41. [DOI: 10.1007/s12630-015-0499-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 08/21/2015] [Accepted: 09/16/2015] [Indexed: 12/12/2022] Open
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Dahlberg D, Ivanovic J, Mariussen E, Hassel B. High extracellular levels of potassium and trace metals in human brain abscess. Neurochem Int 2015; 82:28-32. [DOI: 10.1016/j.neuint.2015.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/02/2015] [Accepted: 02/09/2015] [Indexed: 01/03/2023]
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Seyhan TÖ, Bezen O, Sungur MO, Kalelioğlu I, Karadeniz M, Koltka K. Magnesium Therapy in Pre-eclampsia Prolongs Analgesia Following Spinal Anaesthesia with Fentanyl and Bupivacaine: An Observational Study. Balkan Med J 2014; 31:143-8. [PMID: 25207186 DOI: 10.5152/balkanmedj.2014.13116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 05/07/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Magnesium has anti-nociceptive effects and potentiates opioid analgesia following its systemic and neuraxial administration. However, there is no study evaluating the effects of intravenous (IV) magnesium sulphate (MgSO4) therapy on spinal anaesthesia characteristics in severely pre-eclamptic patients. AIMS The aim of this study was to compare spinal anaesthesia characteristics in severely pre-eclamptic parturients treated with MgSO4 and healthy preterm parturients undergoing caesarean section. Thus, our primary outcome was regarded as the time to first analgesic request following spinal anaesthesia. STUDY DESIGN Case-control Study. METHODS Following approval of Institutional Clinical Research Ethics Committee and informed consent of the patients, 44 parturients undergoing caesarean section with spinal anaesthesia were enrolled in the study in two groups: Healthy preterm parturients (Group C) and severely pre-eclamptic parturients with IV MgSO4 therapy (Group Mg). Following blood and cerebrospinal fluid (CSF) sampling, spinal anaesthesia was induced with 9 mg hyperbaric bupivacaine and 20 μg fentanyl. Serum and CSF magnesium levels, onset of sensory block at T4 level, highest sensory block level, motor block characteristics, time to first analgesic request, maternal haemodynamics as well as side effects were evaluated. RESULTS Blood and CSF magnesium levels were higher in Group Mg. Sensory block onset at T4 were 257.1±77.5 and 194.5±80.1 sec in Group C and Mg respectively (p=0.015). Time to first postoperative analgesic request was significantly prolonged in Group Mg than in Group C (246.1±52.8 and 137.4±30.5 min, respectively, p<0.001; with a mean difference of 108.6 min and 95% CI between 81.6 and 135.7). Side effects were similar in both groups. Group C required significantly more fluids. CONCLUSION Treatment with IV MgSO4 in severe pre-eclamptic parturients significantly prolonged the time to first analgesic request compared to healthy preterm parturients, which might be attributed to the opioid potentiation of magnesium.
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Affiliation(s)
- Tülay Özkan Seyhan
- Department of Anesthesiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Olgaç Bezen
- Department of Anesthesiology, İstanbul Bilim University Faculty of Medicine, İstanbul, Turkey
| | - Mukadder Orhan Sungur
- Department of Anesthesiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Ibrahim Kalelioğlu
- Department of Obstetrics and Gynecology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Meltem Karadeniz
- Department of Anesthesiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Kemalettin Koltka
- Department of Anesthesiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
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Agrawal A, Agrawal S, Payal YS. Effect of continuous magnesium sulfate infusion on spinal block characteristics: A prospective study. Saudi J Anaesth 2014; 8:78-82. [PMID: 24665245 PMCID: PMC3950459 DOI: 10.4103/1658-354x.125945] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Spinal anesthesia is an established mode of anesthesia for lower limb orthopedic surgeries. The limitations of the technique are short duration of action and limited post-operative analgesia. Concomitant use of intravenous infusion of magnesium sulfate may have an effect on the block characteristics and duration of action of intrathecal bupivacaine. Methods: A total of 80 American Society of Anesthesiologists I and II patients, either sex, 20-60 years of age scheduled for elective orthopedic fixation of fracture of long bones of lower limbs under spinal anesthesia were included. Spinal anesthesia administered with 2.5 ml heavy bupivacaine mixed with 10 mcg fentanyl. The groups were then divided to receive an infusion of injection magnesium sulfate 50 mg/kg/h over 15 min followed by 15 mg/kg/h until the end of the surgery (Group M) and 15 ml of Normal Saline over 15 min followed by 100 ml/h until the end of surgery (Group S). Onset, duration of sensory and motor block and amount of post-operative analgesic were noted. Results: A total of 6 patients (Group M) and seven patients (Group S) had inadequate block and excluded from the study. Mean block height was T6. Time required to achieve block height was 8.82 min versus 7.42 min in Groups M and S respectively (P = 0.04). Mean duration of motor block was longer in group M (160.63 ± 17.76 min) compared with Group S (130.12 ± 20.70 min) (P = 0.000). Time for regression of sensory block to T12/L1was 206.88 ± 20.96 min (Group M) and 163.88 ± 15.46 min (Group S) (P = 0.000). Hemodynamic parameters were similar and statistically not significant. Need for first analgesic requirement was after 262.88 ± 21.11 min in group M and 193.25 ± 17.74 min in the group S (P = 0.000). Mean dosage of tramadol needed in first 24 h was less in group M (190 ± 30.38 mg vs. 265 ± 48.30 mg, P = 0.000). Conclusion: Use of intravenous magnesium with spinal anesthesia reduces post-operative pain and analgesic consumption.
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Affiliation(s)
- Akansha Agrawal
- Department of Anesthesia, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Sanjay Agrawal
- Department of Anesthesia, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Yashwant S Payal
- Department of Anesthesia, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
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