Effect of intrathecal magnesium in the presence or absence of local anaesthetic with and without lipophilic opioids: a systematic review and meta-analysis

Morrison, Andra; Hunter, J.M.; Halpern, Stephen H.; Banerjee, A.

doi:10.1093/bja/aet064

Cited by 69 publications

(72 citation statements)

References 51 publications

(39 reference statements)

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“…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.…”

Section: Discussionsupporting

confidence: 58%

“…The magnesium sulfate safety profile has been documented by histopathological analysis in experimental studies (19) .The addition of intrathecal magnesium to intrathecal lipophilic opioid along with local anaesthetics led to delay in the onset of both sensory and motor blockade, along with an increase in the duration of spinal anesthesia. The duration of spinal anesthesia was found to be increased when magnesium was added to opioid with intrathecal local anesthetics compared with a combination of local anaesthetic and opioid mixture(p<0.001) (26) The incidence of adverse events (hypotension, pruritis) was not increased by adding intrathecal magnesium. But it seemed that this drug was enough to provide effective anaesthesia.…”

Section: Discussionmentioning

confidence: 94%

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

R¹,

Indumathi²,

C³

et al. 2014

IOSRJDMS

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 94%

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

R¹,

Indumathi²,

C³

et al. 2014

IOSRJDMS

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“…11,12 Adding magnesium to intrathecal lipophilic opioid with or without local anaesthesia or local anaesthesia only was associated with a significant increase in the duration of spinal anaesthesia. 13 Animal studies have shown that intrathecal magnesium suppresses nociceptive impulses in a neuropathic pain setting, and potentiates opioid antinociception. 6,14 We are not aware of any All values corrected to first decimal place data are presented as mean ± standard deviation *assessed by Bromage score 9 study comparing two different dosages of magnesium sulphate (50 mg, 100 mg) added as adjuvant to intrathecal 0.5% hyperbaric levobupivacaine.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two different doses of magnesium sulphate for spinal anaesthesia: a prospective, randomized double-blind study

et al. 2017

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Background: The present study aim was designed to compare and evaluate the efficacy of adding two different doses of magnesium sulphate to 0.5% hyperbaric levobupivacaine for spinal anaesthesia in terms of block characteristics, haemodynamic and safety profile.Methods: Ninety American Society of Anaesthesiologist (ASA) grade I-II patients undergoing elective infra-umbilical surgeries under spinal anaesthesia were randomly allocated into three groups. Group C (n=30, control group) received 3 mL (15 mg) of 0.5% hyperbaric levobupivacaine; Group M50 (n=30): received 3 mL (15 mg) of 0.5% hyperbaric levobupivacaine + 50 mg of magnesium sulphate. Group M100 (n=30) received 3 mL (15 mg) of 0.5% hyperbaric levobupivacaine + 100 mg of magnesium sulphate. A standard protocol was followed after which a blinded observer assessed the sensory and motor blocks. The onset and duration of sensory (pin-prick) block, onset, intensity and duration of motor block were recorded.Results: All the subarachnoid blocks were adequate. The addition of magnesium sulphate to intrathecal levobupivacaine had not only increased the time to onset of sensory block (p=0.007) but also prolonged the duration of sensory (p<0.001) and motor block (p<0.001) to statistically significant level in a dose dependent manner. Conclusions:Addition of magnesium sulphate does not offer any further advantage in terms of haemodynamic stability. However, it certainly increases the duration of sensory block to a significant level.

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“…Magnesium, a non-competitive NMDA receptor antagonist blocks ion channels in a voltage -dependent fashion thereby preventing central sensitization from peripheral nociceptive stimulation leading to enhanced analgesia [25]. However, it has been reported that ketamine and magnesium inhibit the NMDA system differently [23].There are contradictory reports about the role of intravenous magnesium sulphate in reducing intra-and postoperative analgesic requirements [26] and even at high doses, is associated with limited passage across the blood-brain barrier. An inverse relationship has been demonstrated between the severity of pain with different painful medical and surgical conditions and the serum magnesium concentration [25].…”

Section: Discussionmentioning

confidence: 99%

Comparative Efficacy of Two Different Dosages of Intrathecal Magnesium Sulphate Supplementation in Subarachnoid Block

Kathuria

Luthra

Gupta

et al. 2014

JCDR

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INTRODUCTIONRegional anaesthesia is a safe, inexpensive technique, widely used for lower limb orthopaedic surgery due to the advantage of prolonged post-operative pain relief. Combination with adjuncts [1][2][3][4][5] like epinephrine, clonidine, neostigmine, opioids, midazolam and magnesium [6][7][8][9][10][11][12][13][14][15][16][17][18][19] have been used to prolong analgesia and reduce the incidence of adverse events. These spinal adjuvants allow the use of lower dose of local anaesthetic agents, prolong and intensify the subarachnoid block and offer hemodynamic stability. Opioids such as fentanyl are commonly used as additive to local anaesthetics to prolong the duration and intensify the effects of subarachnoid block. However significant side effects of opioids such as pruritis, urinary retention, respiratory depression, hemodynamic instability and occasionally severe nausea and vomiting may limit their use. Newer methods of prolonging the duration of subarachnoid block and reducing post-operative analgesic requirements are of special interest in major surgical procedures.One of the mechanisms implicated in the persistence of postoperative pain is central sensitization, which is an activity-dependent increase in the excitability of spinal neurons . Central sensitization has been shown to depend on the activation of dorsal hornNmethyl-D aspartate (NMDA) receptors by excitatory amino acid transmitters such as aspartate and glutamate. NMDA receptor antagonists prevent central sensitization induced by peripheral nociceptive stimuli by blocking dorsal horn NMDA receptor activation. Magnesium (Mg 2+) is a non-competitive N-methyl-Daspartate (NMDA) receptor antagonist that blocks ion channels in a voltage dependent fashion. Koining reported that intravenous magnesium administration led to significant reduction in fentanyl consumption in peri and post-operative periods. Studies have evaluated use of magnesium intrathecally and shown to prolong the action of subarachnoid anaesthesia [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. However, most of these studies used an opioid along with magnesium, which could have contributed to the prolongation of blockade after subarachnoid block [6-13], Magnesium alone with LA in a dose of 50 mg and maximum upto 100 mg has been used in a few studies [14][15][16][17][18][19]. Although the results of adding MgSO 4 50 mg to IT bupivacaine are conflicting, the effect of increasing the dose of additional MgSO 4 has not been fully investigated. We used a dose of about 0.7mg/ kg (50 mg) to ≤ 1mg/kg (75 mg) of intrathecal magnesium and found similar results. The primary outcome was the duration of spinal anaesthesia, beginning of sensory and motor block, time to maximal sensory block, and duration of sensory and motor block. The secondary outcomes included hemodynamic variations and post-operative analgesic requirements . MATeRIAlS AND MeThODSWe conducted a randomized double blind study on 90 patients of either sex, belonging to ASA physical status I and II scheduled for orthopaedi...

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Effect of intrathecal magnesium in the presence or absence of local anaesthetic with and without lipophilic opioids: a systematic review and meta-analysis

Cited by 69 publications

References 51 publications

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

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

Comparison of two different doses of magnesium sulphate for spinal anaesthesia: a prospective, randomized double-blind study

Comparative Efficacy of Two Different Dosages of Intrathecal Magnesium Sulphate Supplementation in Subarachnoid Block

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