Comparison of bupivacaine plus magnesium sulfate and ropivacaine plus magnesium sulfate infiltration for postoperative analgesia in patients undergoing lumbar laminectomy: A randomized double-blinded study

Hazarika, Rajib; Parua, Samit; Choudhury, Dipika; Barooah, Rajesh Kumar

doi:10.4103/0259-1162.206859

Cited by 13 publications

(5 citation statements)

References 18 publications

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“…One RCT did not show a significant analgesic benefit after wound instillation [43]. Another RCT compared the infiltration of two different local anaesthetics without a placebo group [45]. It is possible that some of the benefits from local anaesthetic wound instillation may be due to migration of local anaesthetic into the neuraxial planes.…”

Section: Discussionmentioning

confidence: 99%

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Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

et al. 2020

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Purpose With lumbar laminectomy increasingly being performed on an outpatient basis, optimal pain management is critical to avoid post-operative delay in discharge and readmission. The aim of this review was to evaluate the available literature and develop recommendations for optimal pain management after one- or two-level lumbar laminectomy. Methods A systematic review utilizing the PROcedure-SPECific Post-operative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomised controlled trials (RCTs) published in the English language from 1 January 2008 until 31 March 2020—assessing post-operative pain using analgesic, anaesthetic and surgical interventions—were identified from MEDLINE, EMBASE and Cochrane Databases. Results Out of 65 eligible studies identified, 39 RCTs met the inclusion criteria. The analgesic regimen for lumbar laminectomy should include paracetamol and a non-steroidal anti-inflammatory drug (NSAID) or cyclooxygenase (COX)—2 selective inhibitor administered preoperatively or intraoperatively and continued post-operatively, with post-operative opioids for rescue analgesia. In addition, surgical wound instillation or infiltration with local anaesthetics prior to wound closure is recommended. Some interventions—gabapentinoids and intrathecal opioid administration—although effective, carry significant risks and consequently were omitted from the recommendations. Other interventions were also not recommended because there was insufficient, inconsistent or lack of evidence. Conclusion Perioperative pain management for lumbar laminectomy should include paracetamol and NSAID- or COX-2-specific inhibitor, continued into the post-operative period, as well as intraoperative surgical wound instillation or infiltration. Opioids should be used as rescue medication post-operatively. Future studies are necessary to evaluate the efficacy of our recommendations.

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Section: Discussionmentioning

confidence: 99%

“…Hazarika et al compared local wound infiltration with 20 ml of bupivacaine 0.25% combined with magnesium sulphate 500 mg to 20 ml of ropivacaine 0.25% combined with magnesium sulphate 500 mg [45]. Rescue analgesia included IV nalbuphine.…”

Section: Locoregional Anaesthesiamentioning

confidence: 99%

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

et al. 2020

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“…[ 17 ] According to Hazarika et al ., wound infiltration with bupivacaine and magnesium sulfate offered a longer duration of postoperative analgesia and considerably decreased postoperative opioid usage in patients following lumbar laminectomy compared to ropivacaine and magnesium sulfate. [ 18 ] Eldaba et al . discovered that continuous wound infiltration with a mixture of bupivacaine and magnesium sulfate after cesarean section provided effective analgesia and reduced postoperative patient-controlled analgesia requirements when compared to continuous wound infiltration with LA alone or placebo, with fewer opioid adverse effects.…”

Section: Discussionmentioning

confidence: 99%

Analgesic Efficacy of Addition of Magnesium Sulfate to Bupivacaine in Wound Infiltration Technique in Perianal Surgeries

Dave¹,

KUPPUSAMY²,

Krishnan³

et al. 2022

Anesthesia Essays &Amp; Researches

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Background: In peripheral nerve blocks, magnesium sulfate is an excellent adjuvant to local anesthetics. The use of magnesium sulfate as an adjuvant in wound infiltration for postoperative analgesia needs to be investigated. Aims: This study was conducted to evaluate the analgesic efficacy of magnesium sulfate as an adjuvant when added to bupivacaine in wound infiltration technique in perianal surgeries. Settings and Design: This was a prospective, randomized, double-blind study. Materials and Methods: Sixty patients undergoing perianal surgeries were randomly divided into two groups, Group M and Group C. Following perianal surgery, Group M patients received a local wound infiltration of injection magnesium sulfate 750 mg (1.5 mL of injection 50% magnesium sulfate) added to 0.5% bupivacaine 13.5 mL making a total volume of 15 mL, whereas Group C patients received a local wound infiltration of injection 0.5% bupivacaine 13.5 mL and 1.5 mL normal saline. Postoperative vitals and pain scores were assessed. Statistical Analysis Used: Student's t -test for normally distributed continuous data, Mann–Whitney U -test for ordinal data, and Chi-square test or Fisher's exact test, whichever is appropriate for categorical data, were used. Results: The magnesium sulfate group had a lower postoperative pain score, a longer duration of postoperative analgesia, and a lesser number of rescue analgesic doses in the first 24 h. Conclusion: We conclude that magnesium sulfate is an effective adjuvant to bupivacaine for wound infiltration in terms of postoperative analgesia quality and duration following perianal surgeries.

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“…As NMDA receptors are present in both the central nervous system and in the peripheral tissues such as the skin and the muscles, magnesium sulphate with its NMDA receptor antagonistic property, effectively reduces the central and peripheral mechanism of pain transmission, modulation, sensitization. 6,7 Dexmedetomidine is a selective α-2 adrenoreceptor agonist used as sedative as well as adjuvant anesthetic. 3 Several mechanisms have been postulated for its analgesic action which include reduction in conduction of impulses in afferent pain fibers, anti-inflammatory effects by decreasing the production of inflammatory cytokines, α2-adrenergic receptor mediated vasoconstriction leading to prolonged analgesic effect and central analgesic due to its systemic absorption.…”

Section: Discussionmentioning

confidence: 99%

“…The anaesthesiologist explained the visual analogue pain scale (VAS) score to the patient preoperatively and obtained preoperative VAS by asking the average intensity of pain at the pre-anaesthetic check-up, with score 0: No pain, 1-3: Mild pain, 4-6: Moderate pain, 7-9 Severe pain and 10: The worst imaginable pain. 7 In the operating room, standard ASA monitors were attached, and baseline vitals were recorded. All the patients were premedicated with injection fentanyl 2 µg/kg intravenously (IV) followed by induction with IV propofol 2 mg/kg.…”

Section: Exclusion Criteriamentioning

confidence: 99%

Post-operative wound infiltration with dexmedetomidine and magnesium sulphate as adjuvant to levobupivacaine for lumbar laminectomy: a prospective, double blinded, randomized controlled study

et al. 2021

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Background: Wound infiltration with local anaesthetic is safe and effective technique for providing postoperative analgesia following lumbar laminectomy. The objective of this study was to compare the efficacy of local wound infiltration on postoperative analgesia with levobupivacaine, levobupivacaine plus magnesium sulphate and levobupivacaine plus dexmedetomidine in patient undergoing lumbar laminectomy.Methods: Ninety adult patients were randomly allocated into three groups. After the completion of lumbar laminectomy, the drug was locally infiltrated into the paravertebral muscles on either side. Group L received 10 ml of 0.5% levobupivacaine plus 10 ml normal saline, group LM received 10 ml of 0.5% levobupivacaine plus 500 mg magnesium sulphate (1 ml) plus 9 ml normal saline, group LD received 10 ml of 0.5% levobupivacaine plus 50 µg dexmedetomidine (0.5 ml) plus 9.5 ml normal saline. Postoperative visual analogue scale (VAS) pain score at 0, 1, 2, 4, 6, 8, 12 and 24 hours, time to first rescue analgesic drug and its total dose, quality of recovery score (QoR) and side effects were noted.Results: Postoperative VAS was significantly higher in group L as compared to group LM and LD (p<0.05). The time to first rescue analgesic drug was significantly longer in group LD (11.07±7.20 hr) than group LM (6.20±2.64 hr) and group L (3.93±2.70 hr) (p<0.001). The QoR score was significantly better in group LD as compared to group LM and L postoperatively (<0.01).Conclusions: Addition of magnesium sulphate or dexmedetomidine to levobupivacaine for local wound infiltration demonstrated enhanced postoperative analgesia.

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Comparison of bupivacaine plus magnesium sulfate and ropivacaine plus magnesium sulfate infiltration for postoperative analgesia in patients undergoing lumbar laminectomy: A randomized double-blinded study

Cited by 13 publications

References 18 publications

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

Analgesic Efficacy of Addition of Magnesium Sulfate to Bupivacaine in Wound Infiltration Technique in Perianal Surgeries

Post-operative wound infiltration with dexmedetomidine and magnesium sulphate as adjuvant to levobupivacaine for lumbar laminectomy: a prospective, double blinded, randomized controlled study

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