An Evaluation of the Adding Magnesium Sulfate to Ropivacaine on Ultrasound-Guided Transverse Abdominis Plane Block After Abdominal Hysterectomy

Abstract

BackgroundPost-hysterectomy pain is extremely annoying and using transverse abdominis plane (TAP) block can be a useful method to manage postoperative pain, but its duration of effect is challenging. Magnesium sulfate increases, in some cases, the effects of local anesthetics on the peripheral nerve blocks.ObjectivesThe current study aimed at investigating the effects of adding magnesium sulfate to ropivacaine in the transverse abdominis plane block after hysterectomy.MethodsThe current randomized, double blind, clinical trial, to manage postoperative pain, was conducted on a total of 60 patients, 30 - 60 years old, ASA (American Society of Anesthesiologists) class I-II undergone elective abdominal hysterectomy candidates to receive ultrasound-guided bilateral transverse abdominis abdominis plane (TAP) blocks. Patients with coagulation disorders, infection, history of any addiction, sensitivity to the local anesthetics and magnesium sulfate were excluded. The subjects were equally allocated into two groups, the control group, ropivacaine plus normal saline (R), and the study group, ropivacaine plus magnesium sulfate (RM). The injection contained 19 mL ropivacaine 0.2% plus 1 mL normal saline in the group R, and 19 mL ropivacaine 0.2% plus 1 mL magnesium sulfate 50% in the RM group on each side. As well as the patients’ characteristics, the level of pain score (visual analogue scale = VAS), rescue analgesic demand (diclofenac suppository), and possible adverse effects were evaluated at 1, 2, 6, 12, and 24 hours after the operation in the two groups.ResultsThe mean pain scores of the patients at the first hour after surgery were 5.7 ± 0.9 and 5.9 ± 1.1 in R and RM groups, respectively. The scores reached 2.9 ± 0.5 and 2.7 ± 0.4 at the second hour after surgery (the first post-block measurement) and 3.1 ± 0.7 and 2.8 ± 0.7 within the next 24 hours, respectively. Although the pain scores were generally lower at all hours in the RM group, none was statistically significant. The rescue analgesic consumption gradually increased in the two groups, and it was less in the study group than in the control group in the first hours after the block (second hour after surgery); however, it was not statistically significant. No adverse effects were observed in the two groups.ConclusionsResults of the current study suggested that the addition of magnesium sulfate to ropivacaine in TAP block does not affect the post-hysterectomy pain.

Comparing the Effect of Bupivacaine and Ropivacaine in Cesarean Delivery with Spinal Anesthesia

“…Ropivacaine has a greater degree of separation between the motor and sensory blockade than bupivacaine and it is used to relieve epidural pain during labor or for cesarean section (3,4,18,19). Adding auxiliary magnesium sulfate to ropivacaine does not increase the analgesic effect in the transversus abdominis plane block after hysterectomy (20). It is associated with a less central nervous system and other toxicities, especially cardiovascular toxicity.…”

Comparison of the Post-Caesarean Analgesic Effect of Adding Dexmedetomidine to Paracetamol and Ketorolac: A Randomized Clinical Trial

“…A wide range of medications including opioids, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), gabapentin, pregabalin, tramadol, ketamine, and so forth, have been used alone or in combination to achieve this purpose ( 2 - 4 ). Beside systemic drugs, other anesthesia techniques including neuraxial techniques, transverse abdominis plane (TAP) block, wound injection, and intraperitoneal instillation have already been used for pain management after obstetric and gynecologic surgery ( 5 - 9 ). Paracetamol has limited effects to preclude and control post-caesarean pain ( 10 ).…”

The Efficacy of Magnesium Sulfate in Reduction of Post Cardiac Surgery Arrhythmia, Agitation and Pain: A randomized controlled study

“…In a study by Imani et al [7], to assess the effects of magnesium sulfate on intrathecal analgesia after hysterectomy, it was found that magnesium sulfate led to longer duration of analgesia after surgery and reduced postoperative analgesic requirement [7].…”