Comparison of magnesium sulfate and ketamine with ropivacaine in supraclavicular brachial plexus block: A randomized controlled trial

Kaur, Sharan; Dhawan, Jonny; Gupta, Rajesh; Chawla, Sunil

doi:10.4103/aer.aer_96_19

Cited by 8 publications

(8 citation statements)

References 31 publications

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“…in Group F and 2±0 in Group M. At 8 th h Group F was statistically significant. Similar findings were seen in a study done by Kaur et al,19 and Akhondzade et al24 Similar study like Mohan kumar et al15 ., Attri et al17 ., Hashim and Hasan 18 .,Sahi.P et al22 .,Elazyed MA et al23 ., Yangste N et al25 .,Wasudeo B et al 27 ., Mukharjee et al29 ., Iwata et al30 .…”

supporting

confidence: 88%

To evaluate the efficacy of magnesium sulfate and fentanyl as an adjuvant to ropivacaine in supraclavicular brachial plexus block for post-operative pain relief in the upper limb surgeries: A comparative randomized study

Khan

Tandon

Jindal³

et al. 2023

Asian J Med Sci

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Background: Adjuvants to local anesthetics have been used to prolong the duration of analgesia after brachial plexus block surgery. This study evaluates the effects of adding magnesium sulfate and fentanyl with ropivacaine in the supraclavicular brachial plexus block to prolong the duration of analgesia. Aims and Objectives: The aim of the present study was to compare the onset and duration of sensory and motor blockade with the quality of perioperative analgesia and post-operative side effects if any, provided by magnesium sulfate and fentanyl as adjuvants to ropivacaine in supraclavicular block. Materials and Methods: A total of 80 patients with American Society of Anesthesiologists Grade I/II scheduled for elective upper limb surgeries were randomly allocated into two groups. Group M received 30 ml of 0.5% ropivacaine with 250 mg magnesium sulfate and Group F received 30 ml of 0.5% ropivacaine with 50 μg fentanyl for supraclavicular brachial plexus block using PNS guidance. The onset and duration of sensory and motor block, time for the requirement of rescue analgesia, and adverse events during the perioperative period were noted. Results: Onset of sensory block. In group M, the mean onset of sensory blockade was 8.91±1.11 min and in Group F, the mean onset of sensory blockade was 12.12±1.14 min. The mean onset of motor block was 11.57±1.62 min in Group M, and 15.17±1.43 min in Group F. Duration of sensory block is 432.9±38.24 min in Group M and 553.45±39.91 min in Group F, respectively, Duration of motor block in Group M is 392.55±35.22 min and in Group F is 517±44.51 min which was statistically significant. Conclusion: Fentanyl prolonged the duration of sensory and motor block and duration of postoperative analgesia as compared to magnesium sulfate when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block and was not associated with any major adverse events.

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supporting

confidence: 88%

To evaluate the efficacy of magnesium sulfate and fentanyl as an adjuvant to ropivacaine in supraclavicular brachial plexus block for post-operative pain relief in the upper limb surgeries: A comparative randomized study

Khan

Tandon

Jindal³

et al. 2023

Asian J Med Sci

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“…In 161 studies, patients received a supraclavicular brachial plexus block, 26,29–160 in 40 studies, patients received an axillary brachial plexus block, 24,27,161–198 in 28 studies, an interscalene block was performed, 25,199–220 in 11 studies, patients received an infraclavicular brachial plexus block, 221–231 one study used a coracoid approach to brachial plexus block 232 and one study used a suprascapular combined with axillary nerve block 233 . A detailed description of included studies is presented in the supplemental content (supplemental table 3, http://links.lww.com/EJA/A839).…”

Section: Resultsmentioning

confidence: 99%

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

Schubert,

Seneviratne,

Stolz

et al. 2023

European Journal of Anaesthesiology

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BACKGROUNDPeripheral regional anaesthesia is frequently used for upper extremity surgery. To prolong the duration of analgesia, adjuvants can be added to single-injection local anaesthetics. Despite attempts to compare several adjuvants in pairwise meta-analyses, a comprehensive comparison is still missing.OBJECTIVEThe objective of this network meta-analysis was to determine the effectiveness of adjuvants in upper extremity peripheral nerve blocks.DESIGNA systematic review of randomised controlled trials with network meta-analyses.DATA SOURCESA literature search in Embase, CENTRAL, MEDLINE and Web of Science was performed up to March 2023.ELIGIBILITY CRITERIARandomised trials comparing different adjuvants injected perineurally in peripheral upper extremity nerve blocks were eligible. Frequentist network meta-analysis was conducted using a random effects model with physiological saline as the comparator. The primary endpoint was the ratio of means (ROM) of the duration of analgesia.RESULTSThe review included 242 randomised controlled trials with a total of 17 391 patients. Twenty-eight adjuvants were compared in the largest networks. Most network estimations consisted of a high proportion of direct evidence. Fourteen adjuvants increased the duration of analgesia significantly by the following factors, ROM [95% confidence interval (CI)]: dexamethasone 1.95 (1.79 to 2.13), buprenorphine 1.83 (1.51 to 2.24), butorphanol 1.84 (1.41 to 2.39), potassium chloride 1.89 (1.15 to 3.11), dexmedetomidine 1.70 (1.59 to 1.81), sufentanil 1.70 (1.27 to 2.29), ketorolac 1.68 (1.24 to 2.27), midazolam 1.55 (1.24 to 1.94), tramadol 1.52 (1.32 to 1.75), nalbuphine 1.50 (1.30 to 1.72), morphine 1.43 (1.09 to 1.88), magnesium sulfate 1.42 (1.20 to 1.67), clonidine 1.36 (1.24 to 1.50) and fentanyl 1.23 (1.08 to 1.40). Inconsistency in network meta-analysis was substantial. Overall side effect rates were low with all adjuvants.CONCLUSIONThe best interventions to prolong the duration of analgesia were dexamethasone, followed by dexmedetomidine, opioids, electrolytes, ketorolac and midazolam. There are general concerns about the quality of underlying studies and the risk of publication bias.TRIAL REGISTRATIONPROSPERO 2018 CRD42018115722

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“…We selected ropivacaine instead of bupivacaine because of its milder cardiovascular and central nervous system toxicity 32 , and epinephrine and corticosteroids because they potentiate the analgesic effect of ropivacaine [10][11][12]33,34 . We selected MgSO 4 and NaHCO 3 for modifying the conventional cocktail because they have been shown to prolong and enhance the analgesia induced by ropivacaine in surgical procedures other than TKA [17][18][19][20][21] . Our results suggest that these 2 adjuvants deserve further investigation even though they were not mentioned in a recent review of cocktails used in total joint arthroplasty 10 .…”

Section: Discussionmentioning

confidence: 99%

“…We hypothesized that postoperative analgesia might be enhanced and prolonged by adding magnesium sulfate (MgSO 4 ) and sodium bicarbonate (NaHCO 3 ) to the LIA cocktail. MgSO 4 acts as an N-methyl- d -aspartate (NMDA) receptor antagonist in the nervous system and can enhance and prolong ropivacaine-induced brachial plexus blocks 17-19 . NaHCO 3 also increases the quality and duration of ropivacaine-induced brachial plexus blocks and lumbar peridural blocks by converting the nonionized form of ropivacaine to an ionized form, which could close sodium channels and block nerve impulse conduction 20,21 .…”

mentioning

confidence: 99%

Efficacy of a Modified Cocktail for Periarticular Local Infiltration Analgesia in Total Knee Arthroplasty

Wang

Zhao

et al. 2023

Journal of Bone and Joint Surgery

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Background:Periarticular local infiltration analgesia (LIA) is largely utilized for controlling pain after total knee arthroplasty (TKA). The present work aimed to assess the efficacy of a modified LIA cocktail for patients undergoing TKA.Methods:Magnesium sulfate (MgSO4) and sodium bicarbonate (NaHCO3) were added to a conventional LIA cocktail comprising ropivacaine, epinephrine, and dexamethasone. After the safety of this modified cocktail was tested in rats, its efficacy and safety were evaluated in a prospective, double-blinded study including 100 individuals randomized to receive periarticular infiltration of the modified cocktail or a conventional cocktail. The primary outcome was postsurgical use of morphine hydrochloride for rescue analgesia. Secondary outcomes were the time until the first rescue analgesia, postsurgical pain (on a visual analog scale [VAS]), functional recovery (assessed by range of knee motion and ambulation distance), time to discharge, and complication rates.Results:Adding NaHCO3 to the local anesthetics caused some instantaneous precipitation in all cases. Administering the modified cocktail to rats did not obviously damage the injected area of the nerve or surrounding tissues. Administration of the modified cocktail to patients was associated with markedly reduced postsurgical morphine use in the initial 24 hours (4.2 ± 5.0 versus 14.6 ± 8.9 mg, p < 0.001), reduced total morphine use (9.8 ± 8.4 versus 19.6 ± 11.4 mg, p < 0.001), prolonged time to the first rescue analgesia, lower VAS pain scores at rest and during motion at 12 and 24 hours following the operation, better functional recovery on postoperative days 1 and 2, and a shorter hospital stay. The modified and conventional cocktail groups had similar rates of complications.Conclusions:The present modification of a conventional cocktail significantly prolonged analgesia and reduced opioid consumption, which may substantially improve pain control in arthroplasty.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Comparison of magnesium sulfate and ketamine with ropivacaine in supraclavicular brachial plexus block: A randomized controlled trial

Cited by 8 publications

References 31 publications

To evaluate the efficacy of magnesium sulfate and fentanyl as an adjuvant to ropivacaine in supraclavicular brachial plexus block for post-operative pain relief in the upper limb surgeries: A comparative randomized study

To evaluate the efficacy of magnesium sulfate and fentanyl as an adjuvant to ropivacaine in supraclavicular brachial plexus block for post-operative pain relief in the upper limb surgeries: A comparative randomized study

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

Efficacy of a Modified Cocktail for Periarticular Local Infiltration Analgesia in Total Knee Arthroplasty

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