Abstract
Background and Aims: Spinal anaesthesia is commonly used anaesthetic technique in preeclampsia patients. Adding additive in spinal anaesthesia improves block characteristics as well as prolongs post-operative analgesia. In this study we aimed to evaluate the effect of additive magnesium sulphate on sensory and motor block properties.
Methods: This prospective randomized study was conducted on 60 ASA II /III preeclampsia patients planned for caesarean section. Patients were randomly allocated to two groups and were given the following drugs intrathecally as per group allocation: Group Mg received 9 mg of0.5% bupivacaine heavy(1.8 ml)+ 20 microgram of fentanyl 50µg/ml (0.4ml) + 50mg of 50% MgS04 (0.1 ml). Group NS received 9 mg of 0.5% bupivacaine heavy (1.8 ml) + 20 microgram of fentanyl 50µg/ml (0.4ml) + 0.1 ml Normal Saline. Parameters monitored were sensory, motor block characteristics and postoperative analgesia.
Results: Time to regress sensory block to L1 and postoperative analgesia was longerin group Mg. Time for complete motor recovery were significantly longer in group Mg as compared to group NS. Group Mg taken more time for onset of sensory and motor blockade.
Conclusion: Addition of magnesium sulphate at 50mg dose as adjuvants to intrathecal bupivacaine and fentanyl significantly prolongs period of the sensory and motor blockade. It also gives longer postoperative analgesia in preeclampsia patients undergoing caesarean section.
Keywords: Caesarean section, Spinal anesthesia, NMDA antagonists, Magnesium sulphate, Postoperative analgesia.
References
- Sia AT, Fun WL, Tan TU. The ongoing challenges of regional and general anaesthesia in obstetrics. Best Pract Res Clin ObstetGynaecol.2010;24:303-12.
- Gogarten W. Spinal anaesthesia for obstetrics. Best Pract Res Clin Anaesthesiol. 2003;17:377-92.
- Burns SM, Cowan CM. Spinal anaesthesia for caesarean section: current clinical practice. Hospital medicine. 2000;61:855-8.
- Albrecht E, Kirkham KR, Liu SS, Brull R. The analgesic efficacy and safety of neuraxial magnesium sulphate: a quantitative review. 2013 Feb; 68(2):190-202
- Iseri LT, French JH. Magnesium: nature’s physiologic calcium blocker. American Heart Journal1984; 108: 188– 93.
- Woolf CJ, Thompson SW. The induction and maintenance of central sensitization is dependent on N‐methyl‐D‐aspartic acid receptor activation; implications for the treatment of post‐injury pain hypersensitivity states. Pain 1991; 44: 293-9.
- Feria M, Abad F, Sanchez A, Abreu P. Magnesium sulphate injected subcutaneously suppresses autotomy in peripherally deafferented rats. Pain1993; 53: 287– 93.
- Xiao WH, Bennett GJ. Magnesium suppresses neuropathic pain responses in rats via a spinal site of action. Brain Res.1994;666:168-72.
- Kroin JS, McCarthy RJ, Von Roenn N, Schwab B, Tuman KJ, Ivankovich AD. Magnesium sulfate potentiates morphine antinociception at the spinal level. 2000;90:913-7.
- Seyhan TÖ, Bezen O, Sungur MO, Kalelioğlu İ, Karadeniz M, Koltka K. Magnesium therapy in pre-eclampsia prolongs analgesia following spinal anaesthesia with fentanyl and bupivacaine: an observational study. Balkan Med J.2014;2014:143-8.
- Smith JM, Lowe RF, Fullerton J, Currie SM, Harris L, Felker-Kantor E. An integrative review of the side effects related to the use of magnesium sulfate for pre-eclampsia and eclampsia management. BMC pregnancy and childbirth. 2013 Dec;13(1):34.
- Özalevli M, Cetin TO, Unlugenc H, Guler T, Isik G. The effect of adding intrathecal magnesium sulphate to bupivacaine–fentanyl spinal anaesthesia. Acta Anaesthesiol Scand.2005;49:1514-9.
- Malleeswaran S, Panda N, Mathew P, Bagga R. A randomised study of magnesium sulphate as an adjuvant to intrathecal bupivacaine in patients with mild preeclampsia undergoing caesarean section. Int J ObstetAnesth.2010;19:161-6.
- Nath MP, Garg R, Talukdar T, Choudhary D, Chakrabarty A. To evaluate the efficacy of intrathecal magnesium sulphate for hysterectomy under subarachnoid block with bupivacaine and fentanyl: A prospective randomized double blind clinical trial. Saudi journal of anaesthesia. 2012 Jul;6(3):254.
- Kathuria B, Luthra N, Gupta A, Grewal A, Sood D. Comparative efficacy of two different dosages of intrathecal magnesium sulphate supplementation in subarachnoid block. Journal of clinical and diagnostic research: JCDR. 2014 Jun;8(6):GC01.
Corresponding Author
Dr Sateesh Verma
Department of Anesthesiology, King George’s Medical University, Lucknow, India