Comparison of intrathecal magnesium and fentanyl as adjuvants to hyperbaric bupivacaine in preeclamptic parturients undergoing elective cesarean sections

Abstract

A B S T R A C TAims: The aim of this study was to evaluate the onset, duration of sensory and motor block, hemodynamic effects (if any), duration and quality of postoperative analgesia, and adverse effects of magnesium or fentanyl given intrathecally with hyperbaric 0.5% bupivacaine in patients with mild preeclampsia undergoing elective caesarean sections. Materials and Methods: A total of 60 women with mild preeclampsia undergoing elective cesarean section were included in a prospective, double-blind, controlled trial. Patients were randomly assigned to receive spinal anesthesia with 2 mL 0.5% hyperbaric bupivacaine with 12.5 µg fentanyl (Group F) or 0.1 mL of 50% magnesium sulfate (50 mg) (Group M) with 0.15 ml preservative free distilled water. Onset, duration and recovery of sensory and motor block, time to maximum sensory block, duration of spinal anesthesia and postoperative analgesia requirements were studied. Statistical comparison was carried out using the Chi-square or Fisher's exact tests and independent Student's t-test where appropriate. Results: The onset of both sensory and motor block was slower in the magnesium group. The duration of spinal anesthesia (246 min ± 11 min vs. 284 min ± 15 min; P < 0.001) and motor block (186.3 ± 12 min vs. 210 ± 10 min; P < 0.001) were significantly longer in the magnesium group. Total analgesic dose requirement was less in Group M. Hemodynamic parameters were comparable in the two groups. Intrathecal magnesium caused minimal side effects. Conclusions: The addition of magnesium sulfate 50 mg to bupivacaine for sub-arachnoid block in patients with mild preeclampsia undergoing elective cesarean section prolongs the duration of analgesia and reduces postoperative analgesic requirements without additional side effects and adverse neonatal outcomes

Fentanyl Versus Magnesium Sulphate as Adjuvant to Hyperbaric Bupivacaine in Spinal Anesthesia for Elective Cesarean Sections

“…This study agreed with Arora, et al ( 2015) (7) which found that the time to reach maximum block height (5.3 ± 0.5 min vs. 8.7 ± 0.5 min) and the onset of motor block (5 ± 1 min vs. 6 ± 1 min) were significantly slower in Group M than in the Group F.…”

“…This result agreed with Arora, et al (2015) (7) who found that there was no significant differences between both groups in the maximum level of sensory block it was T 4-6 in group M and T 4-6 in group F. Also Katiyar, et al (2015) (15) had the same results.…”

“…The incidence of side effects such as sedation and pruritus was noted and recorded. Pruritus was graded as 0 = none, 1 = mild, and 2 = severe (7) . Sedation was measured using the modified Ramsey Sedation Score (9) as 1 = anxious, restless, 2 = cooperative, oriented, tranquil, 3 = responds to commands only, 4 = brisk response to light glabellar tap or loud noise, 5 = sluggish response to light glabellar tap or loud noise and 6 = no response.…”

“…The incidence of nausea and vomiting was noted and recorded during surgery and postoperative. Nausea and vomiting was graded as 0 = no nausea or vomiting, 1 = nausea without vomiting, 2 = both nausea and vomiting present and 3 = more than 2 episodes of (7) . Intravenous ondansetron was given as rescue medication for vomiting.…”

“…If pain scores is more than 3 even after two doses of diclofenac, then intravenous nalbuphine hydrochloride 10-20 mg was added. Overall patient satisfaction with anesthesia and analgesia was scored at 24 hours as 1 = excellent; 2 = good and 3 = bad (7) .…”