Analgesic effect of adding magnesium sulfate to epidural levobupivacaine in patients with pre-eclampsia undergoing elective cesarean section

Enoxaparin sodium combined with magnesium sulfate in the treatment of severe preeclampsia

Objective

To observe the treatment of severe preeclampsia in newborns with enoxaparin sodium combined with magnesium sulfate.

Methods

A retrospective analysis was conducted on the clinical data of 80 patients with severe preeclampsia admitted to Hefei Second People's Hospital, China from January 2019 to December 2020. Treatment records showed that 40 cases received magnesium sulfate treatment (single group), and 40 cases received enoxaparin sodium combined with magnesium sulfate treatment (combination group). Levels of D-dimer, soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PLGF), Apgar scores of newborns delivered before and after treatment were compared. Gestation weeks and incidence of adverse reactions were analyzed.

Results

After treatment, levels of D-dimer, sfit-1 and adverse reactions in the combination group were significantly lower than those in the single group (P<0.05), and the level of PLGF, newborn Apgar score and length of gestation were significantly higher than those in the single group (P<0.05).

Conclusion

Compared to magnesium sulfate alone, the combination of enoxaparin sodium and magnesium sulfate in the treatment of pregnant women with severe preeclampsia can more effectively regulate the cytokine level of patients, improve pregnancy outcome, and improve neonatal Apgar score. The incidence of adverse reactions is low, making it a safe and efficient treatment modality.

The effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic review

BACKGROUND

This study evaluated the efficacy of epidurally administered magnesium associated with local anesthetics on postoperative pain control.

METHODS

The study protocol was registered in PROSPERO as CRD42021231910. Literature searches were conducted on Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing epidural administration of magnesium added to local anesthetics for postoperative pain in elective surgical adult patients. Primary outcomes were the time to the first Postoperative (PO) Analgesic Request (TFAR), 24-hour postoperative opioid consumption, and Visual Analog Scale (VAS) scores at the first six and 24 postoperative hours. Secondary outcomes included Postoperative Nausea and Vomiting (PONV), pruritus, and shivering. Quality of evidence was assessed using GRADE criteria.

RESULTS

Seventeen studies comparing epidural were included. Effect estimates are described as weighted Mean Differences (MD) and 95% Confidence Intervals (95% CI) for the main outcomes: TFAR (MD = 72.4 min; 95% CI = 10.22-134.58 min; p < 0.001; I² = 99.8%; GRADE: very low); opioid consumption (MD = -7.2 mg (95% CI = -9.30 - -5.09; p < 0.001; I² = 98%; GRADE: very low). VAS pain scores within the first six PO hours (VAS) (MD = -1.01 cm; 95% CI = -1.40-0.64 cm; p < 0.001; I² = 88%; GRADE: very low), at 24 hours (MD = -0.56 cm; 95% CI = -1.14-0.01 cm; p = 0.05; I² = 97%; GRADE: very low).

CONCLUSIONS

Magnesium sulfate delayed TFAR and decreased 24-hour opioid consumption and early postoperative pain intensity. However, imprecision and inconsistency pervaded meta-analyses, causing very low certainty of effect estimates.

Anesthetic Conversion of Preexisting Labor Epidural Analgesia for Emergency Cesarean Section and Efficacy of Levobupivacaine with or Without Magnesium Sulphate: A Prospective Randomized Study

Background: For pregnant women who require an emergency cesarean section (CS), extending labor epidural analgesia as quickly as feasible to good quality anesthesia is a critical issue. This indicates the presence of functional labor epidural analgesia and reduces the need for general anesthesia. Addition of magnesium increases anesthetic and analgesic qualities of epidural anesthesia. Objectives: The purpose of this trial was to assess the role of adding magnesium sulfate (MgSO4) with levobupivacaine to speed up the conversion of labor epidural analgesia into enough anesthesia for emergency CS. Methods: Fifty parturients were randomly assigned to receive 19.5 mL of levobupivacaine 0.5% with either 0.5 mL of normal saline 0.9% (Group I) or 0.5 mL of MgSO4 10% (Group II) after receiving labor epidural analgesia. We documented the onset of block (loss of pinprick to T6), number of patients needing additional analgesia, the time needed for sensory and motor blockade to recover, and the adverse effects. Results: The frequency of patients receiving intraoperative supplements was comparable in the study groups (P = 0.491), although the onset of the block was faster in Group II than in Group I (P = 0.000*). Group II took substantially longer to recover from sensory and motor blockade than Group I (P = 0.001* and P = 0.001*, respectively). In both groups, the occurrence of adverse events was similar. Conclusions: Adding 50 mg of MgSO4 to levobupivacaine 0.5% accelerated the epidural top, and both sensory onset and motor blocks period were prolonged as compared to levobupivacaine alone when extending epidural analgesia for emergency CS.

Magnesium Sulfate Combined with a Levobupivacaine Periarticular Cocktail for Analgesia in the Early Postoperative Period after Total Knee Arthroplasty

This study aimed to evaluate the analgesic effect of magnesium sulfate combined with a levobupivacaine periarticular cocktail in the early postoperative period after total knee arthroplasty (TKA). A total of 60 patients who underwent primary unilateral TKA in our department from March 2018 to May 2019 were prospectively selected and randomly divided into the trial group (30 patients with 20 mL of magnesium sulfate 250 mg + levobupivacaine 50 mg + triamcinolone 25 mg + 0.9% normal saline) and the control group (30 patients with 20 mL of levobupivacaine 50 mg + triamcinolone 25 mg + 0.9% normal saline). Visual analog scale (VAS) scores at 6, 12, 24, 48, and 72 hours postoperatively during rest; VAS scores at 12, 24, 48, and 72 hours postoperatively during motion; the time required to reach 30 degrees straight leg elevation and 60 degrees active knee flexion; and the analgesia pump dosage at 6, 12, 24, and 48 hours postoperatively were recorded. Magnesium sulfate combined with levobupivacaine injection around the knee joint can significantly prolong the time of postoperative analgesia, significantly reduce the use of postoperative analgesics, and effectively alleviate early postoperative pain after TKA.

Magnesium sulfate reduces postoperative pain in women with cesarean section: A meta-analysis of randomized controlled trials

OBJECTIVES

The use of magnesium sulfate (MgSO₄ ) as an adjunct in different anesthetic regimens for cesarean section (CS) delivery often reports conflicting results. This study aimed to review the effectiveness of MgSO₄ on improving postoperative analgesia after CS systematically.

METHODS

PubMed, Embase, and the Cochrane library were searched for randomized controlled trials (RCTs) published from inception to February 2020.

RESULTS

A total of 880 women were included (440 in each group). MgSO₄ had a statistically significant effect compared to the control group on the highest VAS (weighted mean difference [WMD] = -0.74, 95% confidence interval [CI] = -1.03 to -0.46, p < 0.001, I²  = 91.7%, p_{heterogeneity}  < 0.001) and the last VAS (WMD = -0.47, 95% CI = -0.71 to -0.23, p < 0.001, I²  = 95.0%, p_{heterogeneity}  < 0.001). MgSO₄ prolonged the time to the first use of analgesia compared to the control group (standardized mean difference [SMD] = -3.03 min, 95% CI = -4.32 to -1.74, p < 0.001, I²  = 96.3%, p_{heterogeneity}  < 0.001). MgSO₄ decreased the consumption of analgesia compared to the control group (SMD = -3.20 mg of IV morphine equivalent, 95% CI: -5.45 to -0.95, p = 0.005, I²  = 97.6%, p_{heterogeneity}  < 0.001).

DISCUSSION

MgSO₄ decreases the highest VAS in women who underwent general anesthesia, spinal anesthesia, or epidural for CS (all p < 0.05). Additional MgSO₄ significantly reduces postoperative pain in women undergoing CS.

Comparative evaluation of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia: a meta-analysis of randomized controlled trials

Background

The comparative efficacy of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia remains controversial.

Methods

We searched Mediline (OvidSP), EMBASE (OvidSP) and Cochrane Central Register of Controlled Trials (CENTRAL) to identify trials that compared epidural bupivacaine and magnesium sulfate combination (intervention) with bupivacaine alone (control). Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework was used to assess the quality of evidence.

Results

Eleven studies fulfilled our inclusion criteria after screening. We found that epidural bupivacaine combined with magnesium sulfate could prolong the time for first rescue analgesics (SMD 4.96; 95% CI [2.75, 7.17], P < 0.00001, I² = 98%), reduce the number of patients who need rescue analgesics (RR 0.38; 95% CI [0.20, 0.74], P = 0.004, I² = 75%) and requirement for rescue analgesics (SMD -2.65; 95% CI [− 4.23, − 1.06], P = 0.001, I² = 96%).

Conclusions

Magnesium suifate as an adjuvant of epidural bupivacaine improved postoperative analgesia. However, we rated the quality of evidence to be very low because of high heterogeneity, imprecise of results and small sample sizes. Furthermore, further large high-quality trials are still needed to confirm the effects of magnesium sulfate on postoperative analgesia.