Dexmedetomidine versus magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia: a meta-analysis of randomized controlled trials

Wang, Jinguo; Wang, Zaitang; Song, Xuesong; Wang, Na

doi:10.1177/0300060520946171

Cited by 3 publications

(3 citation statements)

References 22 publications

(47 reference statements)

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“…The precise mechanism by which magnesium acts as an analgesic is still ambiguous, but it is suggested that NMDA receptor antagonism and calcium channel blockade are involved. 7,24,25 Numerous researchers [26][27][28] have investigated the effect of MgSO4 in various orthopaedic surgeries, but, to our knowledge, the current study is the first involving limb amputations. Among the more recent ones, 2 studies found significant reduction in pain scores and prolonged time to first analgesia request in patients undergoing arthroscopic knee surgeries under GA and epidural anaesthesia (EA), respectively.…”

Section: Discussionmentioning

confidence: 99%

Attenuation of acute postoperative pain and opioid requirement with the use of magnesium sulfate in patients undergoing limb amputations

Qureshi,

Alam,

Khan

et al. 2024

J Pak Med Assoc

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Objective: To compare the effects of magnesium sulphate on the total dose of intravenous morphine consumption postoperatively following limb amputations along with rescue analgesia requirement, pain scores and side effects. Method: The prospective, triple-blinded, randomised controlled study was conducted from October 2021 to May 2022 at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised patients scheduled for limb amputations. They were randomised into 2 equal groups. The anaesthesia protocol was uniform for all patients. Intervention group A was administered 30mg/kg loading dose and 10mg/kg/hr maintenance dose of magnesium sulphate intravenously, while patients in control group B received the same amount of plain isotonic saline. Morphine consumption was measured for 24 hours postoperatively and included rescue analgesia, if required by the patient in the post-anaesthesia care unit, and patient-controlled analgesia. Numeric rating scale was used for the evaluation of postoperative pain in both groups at 15min, 1h, 2h, at discharge from the post-anaesthesia care unit and at 12h and 24h in the ward. Data was analysed using SPSS 23. Results: Of the 24 patients enrolled, the study was completed by 20(83.33%). There were 10(50%) patients in group A; 8(40%) males and 2(20%) females with mean age 24.8±14.14 years and mean surgery time 130.5±47.86 minutes. There were 10(50%) patients in group B; 8(40%) males and 2(20%) females with mean age 23.2±7.4 years and mean surgery time 117±23.85 minutes (p>0.05). Total morphine used over 24 hours in group A was 16±3.1mg compared to 29.6±11.2mg in group B (p<0.05). The time for first use of patient-controlled analgesia after arriving in the post-anaesthesia care unit was significantly delayed in group A 72.2±24.95 minutes compared to that in group B 25±26.68 minutes (p<0.05). Pain scores were significantly higher in the group B at 15min compared to group A (p<0.05), but not at the rest of the time points (p>0.05). Conclusion: Intravenous magnesium sulphate proved to be effective in lowering postoperative opioid requirement following limb amputations. Key Words: Postoperative pain, Analgesia, Amputation, Surgical amputation, N-methyl-D-aspartate receptors, Magnesium, Magnesium sulphate, Opioid analgesics, Morphine, Patient-controlled analgesia.

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Section: Discussionmentioning

confidence: 99%

Attenuation of acute postoperative pain and opioid requirement with the use of magnesium sulfate in patients undergoing limb amputations

Qureshi,

Alam,

Khan

et al. 2024

J Pak Med Assoc

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“… 7 Dex has been successfully used for spinal and intravenous anesthesia in animals and humans without causing significant respiratory depression, pruritus, nausea, or vomiting. 8 , 9 In addition to epidural administration, Dex has also been administered intrathecally as an adjuvant to local anesthetics to improve the anesthetic effect, provide stable hemodynamic conditions, and prolong postoperative analgesia. 9 , 10 Furthermore, both intrathecal and intravenous injections of Dex alone or as an adjuvant were found to be effective for pain relief.…”

Section: Introductionmentioning

confidence: 99%

“… 8 , 9 In addition to epidural administration, Dex has also been administered intrathecally as an adjuvant to local anesthetics to improve the anesthetic effect, provide stable hemodynamic conditions, and prolong postoperative analgesia. 9 , 10 Furthermore, both intrathecal and intravenous injections of Dex alone or as an adjuvant were found to be effective for pain relief. 11 , 12 Therefore, we hypothesized that Dex also provides an analgesic effect or enhances the analgesic effect of local anesthetics.…”

Section: Introductionmentioning

confidence: 99%

Intrathecal dexmedetomidine improves epidural labor analgesia effects: a randomized controlled trial

Wang²,

et al. 2021

J Int Med Res

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Objective α2‑agonists and opioids have been used as intrathecal adjuvants to local anesthetics for several years, but the effect of intrathecal dexmedetomidine (Dex) or sufentanil combined with epidural ropivacaine in labor analgesia is not fully understood. Methods A total of 108 parturient women receiving combined spinal-epidural labor analgesia were randomly divided into three groups. Group C received l mL saline (0.9%) intrathecally, Group D received 5 µg Dex intrathecally, and Group S received 5 µg sufentanil intrathecally. All parturient women then received 0.1% epidural ropivacaine and 0.2 µg/mL sufentanil for patient-controlled epidural analgesia with standard settings. The visual analog scale score, onset time, duration of intrathecal injection, local anesthetic requirements, and side effects were recorded. Results The labor analgesia effects in Groups D and S were better than those in Group C. Groups D and S displayed significantly shorter onset times, longer durations of intrathecal injection, and reduced local anesthetic requirements compared with Group C. The incidence of shivering and pruritus in Group D was lower than that in Group S. Conclusion Intrathecal administration of 5 µg Dex could improve epidural labor analgesia effects. This randomized controlled clinical trial was registered with the Chinese Clinical Registry Center (ChiCTR-1800014943, http://www.chictr.org.cn/ ).

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Comparative characteristics of the effectiveness of spinal anesthesia based on bupivacaine in combination with different intrathecal doses of dexmedetomidine

Shchegolkov,

Loskutov

2024

ЕМ

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Background. To increase the quality of a block, corresponding adjuvants are used intrathecally. However, currently, the interrelation between different doses of intrathecal dexmedetomidine as an adjuvant, differential analgesia, and the effectiveness of a spinal block is not adequately elucidated. The purpose: to conduct a comparative analysis on the effectiveness of motor (MB) and sensory block (SB), as well as to evaluate the clinical efficiency of analgesia during spinal anesthesia based on bupivacaine in combination with various intrathecal doses of dexmedetomidine. Materials and methods. The study included 150 patients with a mean age of 41.3 ± 8.2 years who underwent biportal endoscopic discectomy. Participants were divided into the following groups: group 1 (n = 30) — intrathecal administration of 2.5 ml bupivacaine combined with intrathecal administration of 2.5 µg dexmedetomidine; group 2 (n = 30) — intrathecal use of 2.5 ml bupivacaine with intrathecal administration of 5 µg dexmedetomidine; group 3 (n = 30) — intrathecal administration of 2.5 ml bupivacaine combined with intrathecal administration of 10 µg dexmedetomidine. In the groups, the sensory and motor status of patients and the level of analgesia were assessed. Results. The time of a SB onset was 22.78 ± 2.04 % higher in group 1 than in group 2 and 37.42 ± 2.75 % higher compared to group 3. The time of a MB onset in group 1 was 9.16 ± 1.32 % higher than in group 2 and 20.17 ± 2.36 % higher compared to group 3. In group 1, the time of a two-segment sensory regression was 21.38 ± 2.18 % lower than in group 2 and 36.40 ± 2.81 % lower than in group 3. The duration of a MB in group 3 was 18.23 ± 2.21 % higher compared to group 2 and 42.39 ± 3.05 % higher than in group 1. In group 3, the indicators of differential analgesia were 110.74 ± 4.53 % higher compared to group 2 and 202.39 ± 5.72 % higher than in group 1. Conclusions. Increasing the intrathecal dose of dexmedetomidine resulted in a reduction in the time of a sensory block onset, while the duration of a motor block increased. The indicators of analgesia duration also directly proportionally increased with the escalation of dexmedetomidine dosage.

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Dexmedetomidine versus magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia: a meta-analysis of randomized controlled trials

Cited by 3 publications

References 22 publications

Attenuation of acute postoperative pain and opioid requirement with the use of magnesium sulfate in patients undergoing limb amputations

Attenuation of acute postoperative pain and opioid requirement with the use of magnesium sulfate in patients undergoing limb amputations

Intrathecal dexmedetomidine improves epidural labor analgesia effects: a randomized controlled trial

Comparative characteristics of the effectiveness of spinal anesthesia based on bupivacaine in combination with different intrathecal doses of dexmedetomidine

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