Preemptive use of epidural magnesium sulphate to reduce narcotic requirements in orthopedic surgery

Kandil, Abir; Hammad, Raafat Abd El Azim; Shafei, M.; El-Ozairy, Hala S.

doi:10.1016/j.egja.2011.10.006

Cited by 10 publications

(25 citation statements)

References 10 publications

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“…In the present study, there were no significant hemodynamic changes between groups. This is in agreement with many authors who used epidural MgSO4 (19) , and did not report any hemodynamic or respiratory instability during the observation period. The results revealed significant difference regarding the sedation score during first hour postoperatively.…”

Section: Discussionsupporting

confidence: 80%

Effect of Adding Magnesium Sulphate to Pediatric Caudal Bupivacaine on Hemodynamics Parameters and Surgical Stress: Randomized Double-Blind Control Study

Aşkar¹,

Ahmed²,

Hassan³

2017

IAM

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Background: Caudal anesthesia/analgesia is simple to perform, reliable and safe. Various adjuvants have been utilized with local anesthetic to prolong duration of post-operative analgesia of caudal block in pediatric patients, but with variable results. Aim and Objective: This study is conducted to evaluate the hemodynamics effects and surgical stress response of caudal magnesium sulfate with bupivacaine in children undergoing lower abdominal surgeries. Methods: The study was approved by the local ethics committee, and a written consent was obtained for each subject, and included 60 children ASA classification I and II, aged 1 year to 6 years scheduled for lower abdominal surgeries randomized into one of two groups. after inhalation induction of general anesthesia, standard caudal block was done the participants were randomized into one of two groups either receive 1ml volume containing 50mg of magnesium sulfate (group Mg) added to 1ml /kg bupivacaine 0.25% or 1ml saline as placebo added to the same dose of bupivacaine in group (C). Postoperative pain assessed by FLACC score (acronym for Face, Legs, Activity, Cry and CONSOL ability) and duration of analgesia, postoperative sedation as well as hemodynamic parameters were compared between the two groups. Results: Group Mg had significantly lower FLACC score than group C in the first six postoperative hours. The sedation score was significantly higher only during the first postoperative hours in group Mg compared to group C. There was no statistically significant difference between groups about hemodynamic parameters at any time during the study period. Conclusion: Caudal magnesium sulfate 50mg enhance caudal block and prolongs duration of analgesia with bupivacaine in pediatric patient undergoing lower abdominal surgeries under general anesthesia with minimum adverse effects.

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Section: Discussionsupporting

confidence: 80%

Effect of Adding Magnesium Sulphate to Pediatric Caudal Bupivacaine on Hemodynamics Parameters and Surgical Stress: Randomized Double-Blind Control Study

Aşkar¹,

Ahmed²,

Hassan³

2017

IAM

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“…Abir Hassan Aly Kandil et al, carried out a prospective randomized double blind study in 60 patients undergoing lower limb orthopedic surgery with the enrollment to receive either 0.5% bupivacaine or 0.5% bupivacaine plus magnesium sulphate 50mg as an initial dose followed by a continuous infusion of 10 mg/hr as epidural analgesia. 17 After the completion of surgery, all patients were given 2µg/mL fentanyl and 0.03% bupivacaine using PCEA device. The PCEA was programmed to deliver 2.5mL/hr infusion with a bolus dose of 1.5ml on demand.…”

Section: Discussionmentioning

confidence: 99%

Clinical evaluation of adding solitary dose of magnesium to fentanyl on post-operative analgesia during combined spinal epidural technique for hip replacement procedures

et al. 2018

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Background: Numerous receptors such as NMDA have evolved in the management of post-operative pain which can be antagonized effectively before the initiation of painful stimuli. The analgesic property of Magnesium is primarily related to the regulation of calcium inﬂux and antagonism of N-methyl-D-aspartate (NMDA) receptors distributed throughout the central nervous system. This study was designed to evaluate if addition of magnesium to epidural fentanyl as pre-emptive solitary dose could prolong post-operative analgesia during combined spinal epidural anesthesia in elective hip replacement surgeries.Methods: A total of 63 adult consented ASA grade I and II patients aged between 40 and 70 years of either sex, who met the inclusion criteria for hip replacement surgery, were randomized to receive either epidural fentanyl (Group I) or combined epidural magnesium sulphate and fentanyl (Group II). Both the groups subsequently received subarachnoid block with 0.5 % heavy bupivacaine. Intraoperative hemodynamic, subarachnoid block characteristics and 24 hours post-operative analgesia was evaluated.Results: There was significant delay in two dermatome regression for the combined fentanyl magnesium group (149.07±6.48 min) compared to fentanyl alone group (121.23±2.92 min). The post-operative VAS score was statistically lower for the combined fentanyl magnesium group (lowest:0.7±0.4 at 4th hr, highest: 2.9±0.3 at 20th hr) compared to fentanyl alone group (lowest:1.86±1.7 at 5th hr, highest: 3.37±0.9 at 4th hr). There was highly significant difference in average time to first epidural top up and 24hrs epidural top up consumption between fentanyl alone group (264.83±34.08min, 2.8±0.5) and combined fentanyl magnesium group (398±69.55min, 1.43±0.5). Total epidural top ups were 84 in fentanyl alone group and 43 in combined fentanyl magnesium group. Hemodynamic parameters were stable in both groups.Conclusions: Pre-emptive co-administration of magnesium sulphate as a solitary dose to epidural fentanyl in CSE technique prolongs the duration of post-operative analgesia, reduce the requirement of epidural top up and provide stable hemodynamic perioperatively compared to epidural fentanyl alone.

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“…The literature search identified 4392 studies totally and 112 references from CENTRAL, 2481 references from MEDLINE (OvidSP), and 1799 studies from Embase (Ovidsp). Eleven studies fulfilled our inclusion criteria after screening [12][13][14][15][16][17][18][19][20][21][22]. The details of retrieval was shown in Fig.…”

Section: Study Selection and Characteristics Of Included Studiesmentioning

confidence: 99%

“…Seven trials applied magnesium sulfate as a bolus followed by a continuous infusion [12][13][14][15][16][17][18], while the remaining four trials applied a bolus injection [19][20][21][22]. In eight studies enrolled participants undergoing Lower abdominal or lower limb surgeries [12,13,15,[17][18][19][20]22], with participants administered epidural anesthesia. Participants in Mohammad 2015 and Radwan 2017 underwent unilateral thoracic surgery and spine surgery respectively with general plus epidural anesthesia.…”

Section: Study Selection and Characteristics Of Included Studiesmentioning

confidence: 99%

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Comparative evaluation of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia: a meta-analysis of randomized controlled trials

Fang

Wang

et al. 2020

BMC Anesthesiol

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Background: The comparative efficacy of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia remains controversial. Methods: We searched Mediline (OvidSP), EMBASE (OvidSP) and Cochrane Central Register of Controlled Trials (CENTRAL) to identify trials that compared epidural bupivacaine and magnesium sulfate combination (intervention) with bupivacaine alone (control). Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework was used to assess the quality of evidence. Results: Eleven studies fulfilled our inclusion criteria after screening. We found that epidural bupivacaine combined with magnesium sulfate could prolong the time for first rescue analgesics (SMD 4.96; 95% CI [2.75, 7.17], P < 0.00001, I 2 = 98%), reduce the number of patients who need rescue analgesics (RR 0.38; 95% CI [0.20, 0.74], P = 0.004, I 2 = 75%) and requirement for rescue analgesics (SMD-2.65; 95% CI [− 4.23, − 1.06], P = 0.001, I 2 = 96%). Conclusions: Magnesium suifate as an adjuvant of epidural bupivacaine improved postoperative analgesia. However, we rated the quality of evidence to be very low because of high heterogeneity, imprecise of results and small sample sizes. Furthermore, further large high-quality trials are still needed to confirm the effects of magnesium sulfate on postoperative analgesia.

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Preemptive use of epidural magnesium sulphate to reduce narcotic requirements in orthopedic surgery

Cited by 10 publications

References 10 publications

Effect of Adding Magnesium Sulphate to Pediatric Caudal Bupivacaine on Hemodynamics Parameters and Surgical Stress: Randomized Double-Blind Control Study

Effect of Adding Magnesium Sulphate to Pediatric Caudal Bupivacaine on Hemodynamics Parameters and Surgical Stress: Randomized Double-Blind Control Study

Clinical evaluation of adding solitary dose of magnesium to fentanyl on post-operative analgesia during combined spinal epidural technique for hip replacement procedures

Comparative evaluation of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia: a meta-analysis of randomized controlled trials

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