Evaluation of magnesium as an adjuvant to ropivacaine-induced axillary brachial plexus block: A prospective, randomised, double-blind study

Deshpande, Jyoti; Patil, Kalyani Nilesh

doi:10.4103/ija.ija_833_19

Cited by 8 publications

(4 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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

View full text Add to dashboard Cite

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

show abstract

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

View full text Add to dashboard Cite

show abstract

“…This prevents hypersensitization by blocking the activation of dorsal horn NMDA receptors induced by excitatory amino acid transmitters. [32][33][34][35][36] Sodium bicarbonate converts ropivacaine from its nonionized form to its ionized form, which has a stronger interaction with the sodium channel receptor. 37 The ionized form of ropivacaine shuts down the sodium channel receptor, blocking nerve impulse conduction and establishing an enhanced and prolonged anesthesia block.…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic Intercostal Nerve Block with Cocktail Analgesics for Pain Control After Video-Assisted Thoracoscopic Surgery: A Prospective Cohort Study

Li,

Dong,

Guo

et al. 2024

JPR

View full text Add to dashboard Cite

To evaluate whether using a cocktail of intercostal nerve blocks (TINB) during thoracoscopic surgery results in better clinical outcomes than patient-controlled analgesia (PCIA). Methods: Patients in two medical groups undergoing video-assisted thoracoscopic surgery (VATS) for pulmonary nodules in West China Hospital of Sichuan University were collected consecutively between March 2022 and December 2022. The groups were divided into two subgroups based on their analgesic program, which were TINB group and PCIA group. The primary outcome was the visual analogue scale (VAS) of the two groups at different stage after surgery and after discharge. Any analgesic related adverse events (ARAEs) were also recorded. Results: A total of 230 patients who underwent VATS were enrolled, in which 113 patients (49.1%) received a cocktail TINB after surgery, and 117 patients (50.9%) received a PCIA. After PSM, 62 patients in each group were selected. The difference of resting VAS (RVAS) and active VAS (AVAS) at different stage during hospitalization was only related to the change of period (p < 0.05, p < 0.05), and the two groups showed no significant differences in RVAS or AVAS during hospitalization (p = 0.271, p = 0.915). However, the rates of dizziness (4.84% vs 25.81%, p = 0.002), nausea and vomiting (0 vs 22.58%, p < 0.05), fatigue (14.52% vs 34.87%, p = 0.012), and insomnia (0 vs 58.06%, p < 0.05) in TINB group were lower than that in PCIA group. Besides, AVAS and RVAS at 7, 14, and 30 days after discharge in TINB group were both significantly lower than that in PCIA group (p < 0.05, p < 0.05). Conclusion: Cocktail TINB provided better analgesia after discharge and reduced the incidence of ARAEs in patients undergoing VATS.

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

Evaluation of magnesium as an adjuvant to ropivacaine-induced axillary brachial plexus block: A prospective, randomised, double-blind study

Cited by 8 publications

References 24 publications

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

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

Thoracoscopic Intercostal Nerve Block with Cocktail Analgesics for Pain Control After Video-Assisted Thoracoscopic Surgery: A Prospective Cohort Study

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

Contact Info

Product

Resources

About