A dose-finding randomised controlled trial of magnesium sulphate as an adjuvant in ultrasound-guided supraclavicular brachial plexus block

Verma, Versha; Rana, Shelly; Chaudhary, Sudarshan Kumar; Singh, J. J.; Verma, Ravinder; Sood, Sunandan

doi:10.4103/ija.ija_466_16

Cited by 15 publications

(4 citation statements)

References 19 publications

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“…[ 5 , 11 - 13 ] Since the total number of studies using MgSO 4 in a dose greater than 250 mg in TAP block was very few,[ 8 , 10 , 14 ] we chose a dose of 250 mg for our study taking into account the safety profile of the drug. MgSO 4 was used in 250 mg based on the data from a study[ 15 ] where MgSO 4 was used in the dose of 125 mg and 250 mg along with bupivacaine in the supraclavicular brachial plexus block.…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of bupivacaine with magnesium sulphate and dexamethasone as adjuvants in ultrasound-guided transversus abdominis plane block for open unilateral inguinal hernia surgeries: A randomised controlled trial

Padhi¹,

Shambhavi²,

Das³

et al. 2023

Indian Journal of Anaesthesia

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Background and Aims: Inguinal hernia repair is associated with moderate to severe pain that is most extreme in the first 24 hours. The aim of this study was to compare the efficacy of dexamethasone versus magnesium sulphate (MgSO 4 ) with bupivacaine in ultrasound-guided transversus abdominis plane (TAP) block for patients undergoing unilateral inguinal hernioplasty. Methods: Eighty patients were randomly allocated to two groups to receive ultrasound-guided TAP block postoperatively with either 20 ml of 0.25% bupivacaine with 8 mg of dexamethasone (Group BD) or 20 ml of 0.25% bupivacaine with 250 mg of MgSO 4 (Group BM). Patients were assessed for the first 24 hours after surgery for pain at rest and movement using a numerical rating scale (NRS). Two mg/kg of tramadol was administered as rescue analgesia. The time to first demand tramadol, total consumption of tramadol, patient satisfaction score and side effects were evaluated. Results: The time to the first dose of rescue analgesia was significantly longer in BD group (596.13 ± 57.93 min) than in the BM group (422.50 ± 51.95 min). The NRS scores in the BD group were significantly lower compared to the BM group both at rest and on movement. The total requirement of tramadol was significantly less in the BD group (154.55 ± 59.11 mg) compared to the BM group (270.25 ± 105.72 mg). The incidence of side effects was lower and patient satisfaction was higher in BD group compared to BM group. Conclusion: Bupivacaine with dexamethasone in TAP block after unilateral open inguinal hernioplasty provides increased duration of analgesia and decreased requirement for rescue analgesics compared to magnesium sulphate, with lesser side effects and better patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Comparative evaluation of bupivacaine with magnesium sulphate and dexamethasone as adjuvants in ultrasound-guided transversus abdominis plane block for open unilateral inguinal hernia surgeries: A randomised controlled trial

Padhi¹,

Shambhavi²,

Das³

et al. 2023

Indian Journal of Anaesthesia

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“…23,24 Dexmedetomidine and other alpha-2 selective adrenergic agonists are effective analgesics when combined with local anesthetics for peripheral blocks. 25 It inhibits current channels that help neurons return from a hyperpolarized state to their normal resting potential. Dex also selectively prevents C-fiber neurons from firing additional action potentials, causing analgesia.…”

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial of dexmedetomidine vs magnesium sulfate as adjuvants to bupivacaine in infraorbital nerve block for perioperative analgesia in pediatric patients undergoing cleft lip surgery

Alansary,

Ali,

Elshafie

2023

Anaesth. pain intensive care

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Background & Objective: Cleft lip surgery is routinely performed in children under general anesthesia (GA). Infraorbital nerve block (IONB) has been used by some anesthetists to enhance the perioperative pain management in addition to the routine intravenous analgesics. We compared the addition of dexmedetomidine (Dex) plus bupivacaine with magnesium sulphate (MgSO4) plus bupivacaine for IONB in combination with GA, regarding their efficacy, effect on the duration of postoperative analgesia, and any adverse events. Methodology: A total of 75 patients, aged 3 months to 7 y, of either sex, were randomly allocated into three equal groups. After induction of GA with a standardized method, Group D received IONB with Dex + bupivacaine; Group M received the nerve block with MgSO4 + bupivacaine, and a control group (Group C) received block with bupivacaine only. Acetaminophen infusion was used when additional analgesic was required in the postop period. The primary outcome was the duration of time until the first analgesic was administered, while the secondary outcomes were the amount of acetaminophen taken within the first 24 h following surgery, pain scores, and the frequency of side effects. Results: The mean time to first requested analgesia was significantly longer in the Group D, followed by the Group M, and it was the shortest in the Group C (13.9 ± 1.7 h, 11.5 ± 2 h, 5.9 ± 1.3 h respectively, P < 0.001). Total acetaminophen consumption and pain scores were significantly lower among the Group D than the Group M and highest in the Group C (P < 0.001). Emergence agitation and vomiting were non-significantly less frequent in the Group D than the Group M and more frequent in the Group C. No significant difference regarding hypotension, bradycardia, and shivering, was observed among all the groups. Respiratory depression was not recorded in any of the groups. Conclusion: Dexmedetomidine and magnesium sulphate, both offered prolonged analgesia when added to bupivacaine for infraorbital nerve block for perioperative analgesia in pediatric patients undergoing cleft lip surgery under general anesthesia. However, dexmedetomidine was superior to magnesium sulphate regarding the duration of postoperative analgesia. Abbreviations: ASA-PS - American Society of Anesthesiologists Physical Status classification; Dex – Dexmedetomidine; FiO2 - Fraction of inspired oxygen; IONB - Infraorbital nerve block; MBP - Mean blood pressure; NIBP - Non-invasive blood pressure; PACU - Post Anesthesia Care Unit Key words Bupivacaine; Cleft Lip; Dexmedetomidine; Infraorbital Nerve Block; Magnesium Sulfate Citation: Alansary AM, Ali MM, Elshafie MA. A randomized controlled trial of dexmedetomidine vs magnesium sulfate as adjuvants to bupivacaine in infraorbital nerve block for perioperative analgesia in pediatric patients undergoing cleft lip surgery. Anaesth. pain intensive care 2023;27(4):514−522; DOI: 10.35975/apic.v27i4.2261 Received: May 22, 2023; Reviewed: June 02, 2023; Accepted: June 11, 2023

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“…Total volume of 25 mL was injected including 20 mL 0.25% bupivacaine plus 3.75 ml NS and 125 mg MgSO4 (1.25 mL) in group (BM) [10] .…”

Section: Methodsmentioning

confidence: 99%

Ultrasound Guided Erector Spinae Block Using Bupivacaine - Magnesium Sulphate Versus Bupivacaine - Dexmedetomidine in Lumbar Spine Surgeries. A Prospective Randomized Trial

Refaat

Abdelmageed

Alwedeny

et al. 2023

Preprint

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Background: Since the introduction of Erector Spinae Plane Block (ESPB) in 2016 it has been used with success in various thoracic, abdominal, and back surgeries. Many theories have been suggested for its mechanism of action, although the exact mechanism remains unknown. Spine surgeries result in significant postoperative pain, while using postoperative opioids provide adequate pain control in most of the cases, some cases still suffer from uncontrolled pain and patients receiving multiple doses of opioids suffer from various side effects including postoperative nausea and vomiting, constipation, and delayed ambulation. The aim of the study was to compare between the adjuvant effect of dexmedetomidine and magnesium sulfate given along with bupivacaine 0.25% in ESPB. Methods: This was a prospective randomized single blinded study including 52 patients divided in 2 groups; one receiving ESPB with a combination of bupivacaine 0.25% and magnesium sulfate and the other receiving the same block with a combination of bupivacaine 0.25% and dexmedetomidine. Statistical analysis for data collected was done using the (Statistical Package for the Social Sciences) version 26. Shapiro-Wilk test was used to check the normality of the data distribution. Quantitative variables were expressed as mean and standard deviation, median, inter-quartile range, minimum and maximum as appropriate. Results: The group receiving bupivacaine and dexmedetomidine showed a significant decrease in intraoperative pulse and blood pressure compared to the other group (p< 0.05). They showed a prolonged postoperative analgesia duration as well and a decreased total opioid consumption (p< 0.05). Conclusion: Although dexmedetomidine results in prolonged postoperative analgesia duration compared to magnesium sulfate when combined with bupivacaine 0.25% in ESPB, its negative effects on hemodynamics should be considered. Trial registration: This trial was registered retrospectively on Clinicaltrials.gov registry (NCT05694897) on 23/1/2023.

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A dose-finding randomised controlled trial of magnesium sulphate as an adjuvant in ultrasound-guided supraclavicular brachial plexus block

Cited by 15 publications

References 19 publications

Comparative evaluation of bupivacaine with magnesium sulphate and dexamethasone as adjuvants in ultrasound-guided transversus abdominis plane block for open unilateral inguinal hernia surgeries: A randomised controlled trial

Comparative evaluation of bupivacaine with magnesium sulphate and dexamethasone as adjuvants in ultrasound-guided transversus abdominis plane block for open unilateral inguinal hernia surgeries: A randomised controlled trial

A randomized controlled trial of dexmedetomidine vs magnesium sulfate as adjuvants to bupivacaine in infraorbital nerve block for perioperative analgesia in pediatric patients undergoing cleft lip surgery

Ultrasound Guided Erector Spinae Block Using Bupivacaine - Magnesium Sulphate Versus Bupivacaine - Dexmedetomidine in Lumbar Spine Surgeries. A Prospective Randomized Trial

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