Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post‐operative analgesic requirements: a prospective, randomized, double‐blind, controlled trial in patients undergoing major orthopedic surgery

Abstract

In patients undergoing orthopedic surgery, supplementation of spinal anesthesia with combined intrathecal and epidural MgSO(4) significantly reduces patients' post-operative analgesic requirements.

Magnesium added to bupivacaine prolongs the duration of analgesia after interscalene nerve block

“…Although the mechanism of analgesia produced by magnesium is not fully understood, many authors have reported that magnesium is associated with a reduced analgesic requirement and less discomfort in the postoperative period via different routes of administration. 7 Most of these studies have investigated systemic 9 or neuraxial, 7,8 administration of magnesium, whereas studies on the administration of magnesium for peripheral nerve block are scarce. 10 The present randomized controlled study was performed to evaluate the effect of adding magnesium sulphate to long-acting local anesthetics (i.e., bupivacaineepinephrine mixture) for interscalene nerve block.…”

“…Another possible mechanism for the analgesic action of magnesium is the voltage-dependent antagonism of NMDA receptors, leading to the prevention of central sensitization from peripheral nociceptive stimulation and a decrease in acute pain after tissue injury. In several investigations [7][8][9] showing effective analgesia due to magnesium sulphate, magnesium was administered via the intravenous or neuraxial route so access to NMDA receptors was probable. However, involvement of NMDA receptors in peripheral blocks is less certain.…”

“…6 The addition of magnesium sulphate to local anesthetics for neuraxial anesthesia prolongs the duration of anesthesia and improves quality of analgesia. [7][8][9] However, there are few clinical studies on the addition of magnesium for peripheral nerve blocks. Gunduz et al 10 found that the addition of magnesium sulphate to 2% prilocaine for axillary brachial plexus block provided marked prolongation of sensory and motor blockades.…”

Effects of adding Magnesium Sulphate to Ropivacaine and Fentanyl for spinal anaesthesia

“…When used with local anaesthetic, it resulted in prolongation of analgesia without significant complication (23,24).This prolongation of anaesthesia is consistent with the experimental synergistic action between spinal local aneasthetic and NMDA antagonists like magnesium sulphate, which use anti -nociceptive effects via different mechanisms; (25,26,27) hence the rationale for combining the two. There are no selective NMDA receptor antagonists available for pain management; hence, drugs with other clinical uses, such as magnesium sulphate and ketamine, shown promises as analgesics, have been used.…”

Evaluation of the Effect of Magnesium Sulphate vs. Clonidine as an Adjuvant to Epidural Levobupivacaine in Patients Undergoing Lower Abdominal Surgeries- A Prospective,randomised and Double-Blinded Study

“…9 Owing to the lower affinity of the S (-) isomer to the cardiac sodium channels compared to the R (+) isomer, it is associated with less cardiac side effects. 10,11 Arcioni et al 12 observed that intrathecal and epidural Magnesium Sulphate potentiated and prolonged motor block. They concluded that patients undergoing orthopaedic surgery, supplementation of spinal anaesthesia with combined intrathecal and epidural MgSO4 significantly reduces post-operative analgesic requirements.…”