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Ding H, Wang C, Ghorbani H, Yang S, Stepanyan H, Zhang G, Zhou N, Wang W. The impact of magnesium on shivering incidence in cardiac surgery patients: A systematic review. Heliyon 2024; 10:e32127. [PMID: 38873687 PMCID: PMC11170178 DOI: 10.1016/j.heliyon.2024.e32127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024] Open
Abstract
Background and objective This scientific review involves a sequential analysis of randomized trial research focused on the incidence of shivering in patients undergoing cardiac surgery. The study conducted a comprehensive search of different databases, up to the end of 2020. Only randomized trials comparing magnesium administration with either placebo or no treatment in patients expected to experience shivering were included. The primary objective was to evaluate shivering occurrence, distinguishing between patients receiving general anesthesia and those not. Secondary outcomes included serum magnesium concentrations, intubation time, post-anesthesia care unit stay, hospitalization duration, and side effects. Data collection included patient demographics and various factors related to magnesium administration. Material and methods This scientific review analyzed 64 clinical trials meeting inclusion criteria, encompassing a total of 4303 patients. Magnesium was administered via different routes, primarily intravenous, epidural, and intraperitoneal, and compared against placebo or control. Data included demographics, magnesium dosage, administration method, and outcomes. Heterogeneity was assessed using the I2 statistic. Some studies were excluded due to unavailability of data or non-responsiveness from authors. Result and discussion: Out of 2546 initially identified articles, 64 trials were selected for analysis. IV magnesium effectively reduced shivering, with epidural and intraperitoneal routes showing even greater efficacy. IV magnesium demonstrated cost-effectiveness and a favorable safety profile, not increasing adverse effects. The exact dose-response relationship of magnesium remains unclear. The results also indicated no significant impact on sedation, extubation time, or gastrointestinal distress. However, further research is needed to determine the optimal magnesium dose and to explore its potential effects on blood pressure and heart rate, particularly regarding pruritus prevention. Conclusion This study highlights the efficacy of intravenous (IV) magnesium in preventing shivering after cardiac surgery. Both epidural and intraperitoneal routes have shown promising results. The safety profile of magnesium administration appears favorable, as it reduces the incidence of shivering without significantly increasing costs. However, further investigation is required to establish the ideal magnesium dosage and explore its potential effects on blood pressure, heart rate, and pruritus prevention, especially in various patient groups.
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Affiliation(s)
- Haiyang Ding
- Department of Anesthesia, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China
- Department of Anesthesia, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China
| | - Chuanguang Wang
- Department of Anesthesia, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China
- Department of Anesthesia, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China
| | - Hamzeh Ghorbani
- Faculty of General Medicine, University of Traditional Medicine of Armenia (UTMA), 38a Marshal Babajanyan St., Yerevan, 0040, Armenia
| | - Sufang Yang
- Department of Anesthesia, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China
- Department of Anesthesia, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China
| | - Harutyun Stepanyan
- Faculty of General Medicine, University of Traditional Medicine of Armenia (UTMA), 38a Marshal Babajanyan St., Yerevan, 0040, Armenia
| | - Guodao Zhang
- Department of Digital Media Technology, Hangzhou Dianzi University, Hangzhou, 310018, China
| | - Nan Zhou
- Department of Anesthesia, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China
- Department of Anesthesia, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China
| | - Wu Wang
- Department of Anesthesia, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China
- Department of Anesthesia, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China
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Modir H, Kokhaei M, Moshiri E, Azami M. Comparative effect of intrathecal meperidine, tramadol, magnesium sulfate, and dexmedetomidine on preventing post-spinal anesthesia shivering and adverse events in hip fracture repair patients: A randomized clinical trial. JOURNAL OF ACUTE DISEASE 2022. [DOI: 10.4103/2221-6189.362813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Wang J, Wang Z, Shi B, Wang N. The effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anesthesia: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e22524. [PMID: 33019455 PMCID: PMC7535640 DOI: 10.1097/md.0000000000022524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
TRIAL DESIGN The current study is a meta-analysis designed to assess the effect of adding magnesium to a combination of intrathecal bupivacaine and fentanyl. METHODS The protocol was registered in PROSPERO with the number CRD42020177618. PubMed, Cochrane library, Web of Science, and Google Scholar were searched for randomized controlled trials investigating the effect of adding magnesium to a combination of intrathecal bupivacaine and fentanyl. The continuous data were presented as Ratio of means (RoM). Risk ratio (RR) along with 95% confidence interval (CI) was utilized to assess the dichotomous data. RESULTS Ten trials were involved in the present study with 720 adult patients. Compared with control, intrathecal magnesium prolonged time to the first analgesic requirement by an estimate of 1.23 (RoM: 1.23; 95%CI: 1.13-1.33; P < .00001), prolonged adequate sensory block duration for surgery by an estimate of 1.16 (RoM: 1.16; 95%CI: 1.05-1.27; P = .003), delayed time to maximum sensory level by an estimate of 1.38 (RoM: 1.38; 95%CI: 1.07-1.78; P = .01) and reduced the incidence of shivering following spinal anesthesia (risk ratio: 0.38; 95%CI: 0.18 to 0.81, P = .01) without influence on time to full motor recovery or incidences of hypotention, bradycardia, nausea, and vomiting or pruritis. CONCLUSION Intrathecal magnesium, when added to a combination of intrathecal bupivacaine and fentany, prolongs the analgesic duration of spinal anesthesia without increased incidences of side effects.
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Affiliation(s)
- Jinguo Wang
- Department of Urology, the First Hospital of Jilin University, Changchun, Jilin
| | - Zaitang Wang
- Department of Taxation, School of Public Economics and Administration of Shanghai University of Finance and Economics, Shanghai
| | - Bo Shi
- Department of Anesthesiology, the First Hospital of Jilin University Changchun, Jilin, China
| | - Na Wang
- Department of Anesthesiology, the First Hospital of Jilin University Changchun, Jilin, China
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Omar H, Aboella WA, Hassan MM, Hassan A, Hassan P, Elshall A, Khaled D, Mostafa M, Tawadros PZ, Hossam Eldin M, Wedad M, Abdelhamid BM. Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery; (RCT). BMC Anesthesiol 2019; 19:190. [PMID: 31651246 PMCID: PMC6814123 DOI: 10.1186/s12871-019-0853-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 09/20/2019] [Indexed: 12/21/2022] Open
Abstract
Background Hypothermia and shivering are common complications after spinal anaesthesia, especially after uroscopic procedures in which large amounts of cold intraluminal irrigation fluids are used. Magnesium sulfate and dexmedetomidine are the most effective adjuvants with the least side effects. The aim of this study was to compare the effects of intrathecal dexmedetomidine versus intrathecal magnesium sulfate on the prevention of post-spinal anaesthesia shivering. Methods This prospective randomized, double-blinded controlled study included 105 patients who were scheduled for uroscopic surgery at the Kasr El-Aini Hospital. The patients were randomly allocated into three groups. Group C (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 0.5 ml of normal saline, Group M (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 25 mg of magnesium sulfate in 0.5 ml saline, and Group D (n = 35) received 2.5 ml of hyperbaric bupivacaine 0.5% (12.5 mg) + 5 μg of dexmedetomidine in 0.5 ml saline. The primary outcomes were the incidence and intensity of shivering. The secondary outcomes were the incidence of hypothermia, sedation, the use of meperidine to control shivering and complications. Results Group C had significantly higher proportions of patients who developed shivering (21), developed grade IV shivering (20) and required meperidine (21) to treat shivering than group M (8,5,5) and group D (5,3,6), which were comparable to each other. The time between block administration and meperidine administration was similar among the three groups. Hypothermia did not occur in any of the patients. The three groups were comparable regarding the occurrence of nausea, vomiting, bradycardia and hypotension. All the patients in group C, 32 patients in group M and 33 patients in group D had a sedation score of 2. Three patients in group M and 2 patients in group D had a sedation score of 3. Conclusions Intrathecal injections of both dexmedetomidine and magnesium sulfate were effective in reducing the incidence of post-spinal anaesthesia shivering. Therefore, we encourage the use of magnesium sulfate, as it is more physiologically available, more readily available in most operating theatres and much less expensive than dexmedetomidine. Trial registration Clinical trial registration ID: Pan African Clinical Trial Registry (PACTR) Trial Number PACTR201801003001727; January 2018, “retrospectively registered”.
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Affiliation(s)
- Heba Omar
- Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Amany Hassan
- Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Passaint Hassan
- Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Elshall
- Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Khaled
- Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha Mostafa
- Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mona Hossam Eldin
- Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mai Wedad
- Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Kawakami H, Nakajima D, Mihara T, Sato H, Goto T. Effectiveness of Magnesium in Preventing Shivering in Surgical Patients: A Systematic Review and Meta-analysis. Anesth Analg 2019; 129:689-700. [PMID: 31425208 DOI: 10.1213/ane.0000000000004024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Clinical trials regarding the antishivering effect of perioperative magnesium have produced inconsistent results. We conducted a systematic review and meta-analysis with Trial Sequential Analysis to evaluate the effect of perioperative magnesium on prevention of shivering. METHODS We searched PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and 2 registry sites for randomized clinical trials that compared the administration of magnesium to a placebo or no treatment in patients undergoing surgeries. The primary outcome of this meta-analysis was the incidence of shivering. The incidence of shivering was combined as a risk ratio with 95% CI using a random-effect model. The effect of the route of administration was evaluated in a subgroup analysis, and Trial Sequential Analysis with a risk of type 1 error of 5% and power of 90% was performed. The quality of each included trial was evaluated, and the quality of evidence was assessed using the Grading of Recommendation Assessment, Development, and Evaluation approach. We also assessed adverse events. RESULTS Sixty-four trials and 4303 patients (2300 and 2003 patients in magnesium and control groups, respectively) were included. The overall incidence of shivering was 9.9% in the magnesium group and 23.0% in the control group (risk ratio, 0.42; 95% CI, 0.33-0.52). Subgroup analysis revealed that the incidence of shivering was lower with IV (risk ratio, 0.29; 95% CI, 0.29-0.54; Grading of Recommendation Assessment, Development, and Evaluation, moderate), epidural (risk ratio, 0.24; 95% CI, 0.13-0.43; Grading of Recommendation Assessment, Development, and Evaluation, low), and intrathecal administration (risk ratio, 0.64; 95% CI, 0.43-0.96; Grading of Recommendation Assessment, Development, and Evaluation, moderate). Only trials with low risk of bias were included for Trial Sequential Analysis. The Z-cumulative curve for IV magnesium crossed the Trial Sequential Analysis monitoring boundary for benefit even though only 34.9% of the target sample size had been reached. The Z-cumulative curve for epidural or intrathecal administration did not cross the Trial Sequential Analysis monitoring boundary for benefit. No increase in adverse events was reported. CONCLUSIONS Perioperative IV administration of magnesium effectively reduced shivering and Trial Sequential Analysis suggested that no more trials are required to confirm that IV magnesium effectively reduces shivering.
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Affiliation(s)
| | - Daisuke Nakajima
- Intensive Care Department, Yokohama City University Medical Center, Yokohama, Japan
| | - Takahiro Mihara
- Education and Training Department, Yokohama City University Hospital, YCU Center for Novel and Exploratory Clinical Trials, Yokohama, Japan
- Department of Anesthesiology, Yokohama City University, School of Medicine, Yokohama, Japan
| | | | - Takahisa Goto
- Department of Anesthesiology, Yokohama City University, School of Medicine, Yokohama, Japan
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The Effect of Magnesium Sulfate on Postoperative Pain Severity and Complications in Patients Undergoing Coronary Artery Bypass Grafting. Res Cardiovasc Med 2017. [DOI: 10.5812/cardiovascmed.59532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Nadri S, Mahmoudvand H, Moradkhani MR. Magnesium Sulfate Mediates Morphine Administration Reduction in Varicocelectomy Surgery. J INVEST SURG 2017; 31:173-177. [PMID: 28332859 DOI: 10.1080/08941939.2017.1299819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS Varicocelectomy is the most common operation carried out by doctors for male infertility treatment. The aim of varicocele treatment is to hinder the refluxing venous drainage to the testis, retaining arterial inflow, and lymphatic drainage. A lot of pain is generated after this surgery, and the use of opium should be reduced to nearest minimum, as all drugs are toxins. Thus the aim of the present study is to facilitate morphine usage reduction after varicocelectomy surgery. MATERIAL AND METHODS One-hundred (100) patients who were varicocelectomy candidate were randomized into two groups: experimental group contain 50 patients and control group contain 50 patients as well. In experimental group, 2 mL magnesium sulfate in 2 mL normal saline was injected into patient immediately after surgery. The control group received only 4 mL normal saline. Morphine dosage administered, and severity of pain monitoring was accessed and recorded with a visual analogue scale (VAS). RESULT Result indicated that administration of morphine dosage in the test group 0.21 ± 0.64 mg was significantly lower as compared to the control group 0.75 ± 1.30 mg during the first 24-hour after surgery (p = 0.01). Average VAS scores in the experimental and control groups in the first 4-hour interval were 0.91 ± 1.30 and 2.9 ± 2.50 (p = 0.02) respectively. We observed a significant difference in the VAS score for pain severity and the dosages of morphine administered. CONCLUSIONS The experimental group with magnesium sulfate in its drug formulation showed better pain control compared to the control group which received only normal saline, whose pain manifested after every few hours. This can be used for the formulation of opium for this surgery in a large scale.
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Affiliation(s)
- Sedigheh Nadri
- a Department of Anesthesiology , Lorestan University of Medical Sciences , Khorramabad , Iran
| | - Hormoz Mahmoudvand
- b Department of Surgery , Lorestan University of Medical Sciences , Khorramabad , Iran
| | - Mahmoud Reza Moradkhani
- a Department of Anesthesiology , Lorestan University of Medical Sciences , Khorramabad , Iran
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Khandelwal M, Dutta D, Bafna U, Chauhan S, Jetley P, Mitra S. Comparison of intrathecal clonidine and magnesium sulphate used as an adjuvant with hyperbaric bupivacaine in lower abdominal surgery. Indian J Anaesth 2017; 61:667-672. [PMID: 28890563 PMCID: PMC5579858 DOI: 10.4103/ija.ija_610_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background and Aims: Use of various adjuvants to spinal anaesthesia is a well-known modality to provide intra- and post-operative analgesia. This study was designed to evaluate and compare the analgesic efficacy of clonidine and magnesium when used as an additive to intrathecal 0.5% hyperbaric bupivacaine. Methods: Ninety patients of the American Society of Anesthesiologists’ physical status grade I or II, scheduled for lower abdominal surgery under spinal anaesthesia, were randomly allocated into three groups. Group B received 3 mL of 0.5% hyperbaric bupivacaine with 1 mL of normal saline, Group C received 3 mL of 0.5% hyperbaric bupivacaine with 1 mL (30 μg) of clonidine and Group M received 3 mL of 0.5% hyperbaric bupivacaine with 1 mL (50 mg) magnesium sulphate. The primary outcome variable was duration of analgesia and secondary outcome variables included onset and duration of sensory and motor block, sedation level and adverse effects. Data were analysed with ANOVA, Kruskal–Wallis and Chi-square tests. Results: The time to first rescue analgesia was significantly (P < 0.01) longer in the Group C (330.7 ± 47.7 min) than both Groups. Group M (246.3 ± 55.9 min) showed significantly prolonged analgesia than Group B (134.4 ± 17.9 min). Group C and Group M showed significantly prolonged duration of both sensory and motor block compared to Group B. Conclusion: Intrathecal clonidine added to bupivacaine prolongs the duration of post-operative analgesia, and hastens the onset and prolongs the duration of sensory and motor block compared to magnesium or controls.
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Affiliation(s)
- Mamta Khandelwal
- Department of Anaesthesiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Debojyoti Dutta
- Department of Anaesthesiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Usha Bafna
- Department of Anaesthesiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Sunil Chauhan
- Department of Anaesthesiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Pranav Jetley
- Department of Anaesthesiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Saikat Mitra
- Department of Anaesthesiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
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Does Magnesium Sulfate as an Adjuvant of Local Anesthetics Facilitate Better Effect of Perineural Nerve Blocks? Clin J Pain 2016; 32:1053-1061. [DOI: 10.1097/ajp.0000000000000356] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Yadav M, Kumar PB, Singh M, Gopinath R. Intrathecal magnesium sulfate as a spinal adjuvant in two different doses, combined with 0.5% heavy bupivacaine for infraumbilical surgeries. Anesth Essays Res 2015; 9:364-8. [PMID: 26712975 PMCID: PMC4683476 DOI: 10.4103/0259-1162.159764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The spinal anesthesia has the definitive advantage that profound nerve block can be produced in a large part of the body by the relatively simple injection of a small amount of local anesthetic.
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Affiliation(s)
- Monu Yadav
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - P Bhanu Kumar
- Department of Anaesthesia, Cornwall Regional Hospital, Montego Bay, Jamaica
| | - Madhavi Singh
- Axon Anaesthesia Associates Private Limited, Hyderabad, Telangana, India
| | - Ramachandran Gopinath
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Katiyar S, Dwivedi C, Tipu S, Jain RK. Comparison of different doses of magnesium sulphate and fentanyl as adjuvants to bupivacaine for infraumbilical surgeries under subarachnoid block. Indian J Anaesth 2015; 59:471-5. [PMID: 26379289 PMCID: PMC4551023 DOI: 10.4103/0019-5049.162982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Spinal anaesthesia is used for many years for surgeries below the level of umbilicus. It has certain disadvantages such as limited duration of blockade and post-operative analgesia. This study was undertaken to evaluate the effects of additives fentanyl and magnesium sulphate along with bupivacaine during spinal anaesthesia for prolongation of analgesia and motor blockade. Methods: This randomised study was conducted in 120 patients of either sex of American Society of Anesthesiologists physical status I and II, posted for infraumbilical surgeries. Patients were randomly allocated to four groups and were given the following drugs intrathecally as per group distribution; group A - bupivacaine 15 mg (0.5% heavy) with fentanyl 25 μg, group B - bupivacaine 15 mg (0.5% heavy) with magnesium 100 mg, group C - bupivacaine 15 mg (0.5% heavy) with magnesium 50 mg and group D - bupivacaine 15 mg (0.5% heavy) with 0.5 ml normal saline. Parameters monitored were duration of analgesia along with haemodynamic parameters and side effects. Data were analysed using the Student's t-test for the continuous variables and two-tailed Fisher exact test or Chi-square test for categorical variables. Results: There was significant increase in duration of analgesia in group A (374.37 min) and B (328.13 min) as compared to group C (274.87 min) and D (246.03 min). In group A, all haemodynamic parameters decreased by more than 20%, compared to baseline parameters, which was clinically and statistically significant as compared to other groups. There was also increase in duration of motor blockade in groups A and B. Conclusion: Addition of magnesium sulphate at 100 mg dose or fentanyl 25 μg as adjuvants to intrathecal bupivacaine significantly prolongs the duration of analgesia, though in the given doses, magnesium provides better haemodynamic stability than fentanyl, with fewer side effects.
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Affiliation(s)
- Sarika Katiyar
- Department of Anesthesiology and Critical Care, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India
| | - Chhavi Dwivedi
- Department of Anesthesiology and Critical Care, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India
| | - Saifullah Tipu
- Department of Anesthesiology and Critical Care, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India
| | - Rajnish K Jain
- Department of Anesthesiology and Critical Care, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India
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Das A, Halder S, Chattopadhyay S, Mandal P, Chhaule S, Banu R. Effect of Two Different Doses of Dexmedetomidine as Adjuvant in Bupivacaine Induced Subarachnoid Block for Elective Abdominal Hysterectomy Operations: A Prospective, Double-blind, Randomized Controlled Study. Oman Med J 2015; 30:257-63. [PMID: 26366259 DOI: 10.5001/omj.2015.52] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Improvements in perioperative pain management for lower abdominal operations has been shown to reduce morbidity, induce early ambulation, and improve patients' long-term outcomes. Dexmedetomidine, a selective alpha-2 agonist, has recently been used intrathecally as adjuvant to spinal anesthesia to prolong its efficacy. We compared two different doses of dexmedetomidine added to hyperbaric bupivacaine for spinal anesthesia. The primary endpoints were the onset and duration of sensory and motor block, and duration of analgesia. . METHODS A total of 100 patients, aged 35-60 years old, assigned to have elective abdominal hysterectomy under spinal anesthesia were divided into two equally sized groups (D5 and D10) in a randomized, double-blind fashion. The D5 group was intrathecally administered 3ml 0.5% hyperbaric bupivacaine with 5µg dexmedetomidine in 0.5ml of normal saline and the D10 group 3ml 0.5% bupivacaine with 10µg dexmedetomidine in 0.5ml of normal saline. For each patient, sensory and motor block onset times, block durations, time to first analgesic use, total analgesic need, postoperative visual analogue scale (VAS) scores, hemodynamics, and side effects were recorded. . RESULTS Although both groups had a similar demographic profile, sensory and motor block in the D10 group (p<0.050) was earlier than the D5 group. Sensory and motor block duration and time to first analgesic use were significantly longer and the need for rescue analgesics was lower in the D10 group than the D5 group. The 24-hour VAS score was significantly lower in the D10 group (p<0.050). Intergroup hemodynamics were comparable (p>0.050) without any appreciable side effects. . CONCLUSION Spinal dexmedetomidine increases the sensory and motor block duration and time to first analgesic use, and decreases analgesic consumption in a dose-dependent manner.
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Affiliation(s)
- Anjan Das
- Department of Anesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Susanta Halder
- Department. of Anesthesiology, Radha Gobinda Kar Medical College and Hospital, Kolkata, India
| | - Surajit Chattopadhyay
- Department of Anesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Parthajit Mandal
- Department of Gynecology and Obstetrics, College of Medicine & Sagore Dutta Hospital, Kolkata, India
| | - Subinay Chhaule
- Department of Anesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Rezina Banu
- Department of Gynecology and Obstetrics, Murshidabad Medical College, Berhampur, India
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Mukherjee K, Das A, Basunia SR, Dutta S, Mandal P, Mukherjee A. Evaluation of Magnesium as an adjuvant in Ropivacaine-induced supraclavicular brachial plexus block: A prospective, double-blinded randomized controlled study. J Res Pharm Pract 2014; 3:123-9. [PMID: 25535620 PMCID: PMC4262858 DOI: 10.4103/2279-042x.145387] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: Different additives have been used to prolong brachial plexus block. We evaluated the effect of adding magnesium sulfate to ropivacaine for supraclavicular brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia. Methods: One hundred patients (25–55 years) posted for elective forearm and hand surgeries under supraclavicular brachial plexus block were divided into two equal groups (Groups RM and RN) in a randomized, double-blind fashion. In group RM (n = 50), 30 ml 0.5% ropivacaine plus 150 mg (in 1 ml 0.9% saline) magnesium sulfate and in group RN (n = 50), 30 ml 0.5% ropivacaine plus 1 ml normal saline were administered in supraclavicular block. Sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, postoperative visual analog scale (VAS), hemodynamic variables, and side effects were recorded for each patient. Findings: Though with similar demographic profile and block (sensory and motor) onset time, the sensory and motor block duration and time to first analgesic use were significantly longer and the total need for rescue analgesics was lower in group RM (P = 0.026) than group RN. Postoperative VAS values at 24 h were significantly lower in group RM (P = 0.045). Intraoperative hemodynamics was comparable among two groups and no appreciable side effect was noted throughout the study period. Conclusion: It can be concluded from this study that adding magnesium sulfate to supraclavicular brachial plexus block may increase the sensory and motor block duration and time to first analgesic use, and decrease total analgesic needs, with no side effects.
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Affiliation(s)
- Kasturi Mukherjee
- Department of Biochemistry, Medical College, Kolkata, West Bengal, India
| | - Anjan Das
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Sandip Roy Basunia
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Soumyadip Dutta
- Department of Orthopedics, R.G Kar Medical College, Kolkata, West Bengal, India
| | - Parthajit Mandal
- Department of G and O, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Anindya Mukherjee
- Department of Anaesthesiology, N.R.S Medical College and Hospital, Kolkata, West Bengal, India
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14
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Gilani MT, Zirak N, Razavi M. Accidental intrathecal injection of magnesium sulfate for cesarean section. Saudi J Anaesth 2014; 8:562-4. [PMID: 25422620 PMCID: PMC4236949 DOI: 10.4103/1658-354x.140906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Magnesium sulfate is used frequently in the operation room and risks of wrong injection should be considered. A woman with history of pseudocholinesterase enzyme deficiency in the previous surgery was referred for cesarean operation. Magnesium sulfate of 700 mg (3.5 ml of 20% solution) was accidentally administered in the subarachnoid space. First, the patient had warm sensation and cutaneous anesthesia, but due to deep tissue pain, general anesthesia was induced by thiopental and atracurium. After the surgery, muscle relaxation and lethargy remained. At 8-10 h later, muscle strength improved and train of four (TOF) reached over 0.85, and then the endotracheal tube was removed. The patient was evaluated during the hospital stay and on the anesthesia clinic. No neurological symptoms, headache or backache were reported. Due to availability of magnesium sulfate, we should be careful for inadvertent intravenous, spinal and epidural injection; therefore before injection must be double checked.
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Affiliation(s)
- Mehryar Taghavi Gilani
- Department of Anesthesia, Cardiac Anesthesia Research Center, Imam-Reza Hospital, Mashhad, Iran
| | - Nahid Zirak
- Department of Anesthesia, Cardiac Anesthesia Research Center, Imam-Reza Hospital, Mashhad, Iran
| | - Majid Razavi
- Department of Anesthesia, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
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15
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Kathuria B, Luthra N, Gupta A, Grewal A, Sood D. Comparative efficacy of two different dosages of intrathecal magnesium sulphate supplementation in subarachnoid block. J Clin Diagn Res 2014; 8:GC01-5. [PMID: 25120997 PMCID: PMC4129284 DOI: 10.7860/jcdr/2014/8295.4510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 04/04/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Spinal anaesthesia is the primary anaesthetic technique for many types of surgeries. Adjuncts to the local anaesthetics (LA) used in spinal anaesthesia can exhibit undesirable side-effects like respiratory depression, urinary retention, pruritis, haemodynamic instability and nausea and vomiting, limiting their use. Magnesium when used in therapeutic doses avoids all of these side-effects. MATERIALS AND METHODS We conducted a randomized double blind study on 90 patients, 30 in each group, scheduled for orthopaedic lower limb surgery under subarachnoid block. Group I: received bupivacaine (0.5%), 12.5 mg + 0.5 ml of preservative free 0.9% normal saline, Group II received bupivacaine (0.5%), 12.5 mg + 0.2 ml (50 mg) of preservative free 25 % magnesium sulphate + 0.3 ml of preservative free 0.9% normal saline Group III: received bupivacaine (0.5%) 12.5 mg + 0.3 ml (75 mg) of 25 % magnesium sulphate + 0.2 ml of preservative free 0.9% normal saline for subarachnoid block. The onset and duration of sensory block, the highest dermatomal level of sensory block, motor block, time to complete motor block recovery and duration of spinal anaesthesia were recorded. STATISTICAL ANALYSIS ANOVA was applied to determine the significance of difference between different groups. If p-value was significant then Turkey's Post Hoc Multicomparison test was applied. Values of p<0.05 were considered to be statistically significant. RESULTS The time of maximum sensory block, time of onset of motor block, duration of sensory block, duration of motor block and time of analgesia request were prolonged in patients given magnesium 50mg and 75mg along with local anaesthetic intrathecally. CONCLUSION N-methyl-D-aspartate (NMDA) receptor antagonist, magnesium when administered intrathecally along with local anaesthetics prolongs the duration of spinal analgesia without adverse effects.
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Affiliation(s)
- Binesh Kathuria
- Senior Resident, Department of Anaesthesia, GMCH 32, Chandigarh, India
| | - Neeru Luthra
- Assistant Professor, Department of Anaesthesia, DMCH, Dayanand-Medical-College-Hospital-, Ludhiana, India
| | - Aanchal Gupta
- Intern, DMCH, Dayanand-Medical-College-Hospital-, Ludhiana, India
| | - Anju Grewal
- Professor, Department of Anaesthesia, DMCH, Dayanand-Medical-College-Hospital-, Ludhiana, India
| | - Dinesh Sood
- Professor, Department of Anaesthesia, DMCH, Dayanand-Medical-College-Hospital-, Ludhiana, India
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