COMPARATIVE STUDY ON INTRATHECAL MAGNESIUM SULFATE AND FENTANYL AS A SPINAL ADJUVANT, COMBINED WITH 0.5% HYPERBARIC BUPIVACAINE FOR INFRAUMBILICAL SURGERIES
Main Article Content
Keywords
spinal anaesthesia, hyperbaric bupivacaine, magnesium sulphate, fentanyl
Abstract
- Introduction
Spinal anesthesia benefits from adjuvants that prolong block duration. Fentanyl is widely used, but magnesium sulfate, a non-opioid NMDA antagonist, is emerging as a promising alternative in regional anesthesia. - Aims and Objectives
This study aims to evaluate and compare the onset, duration, and safety profile of intrathecal magnesium sulfate versus fentanyl, with a control group, to determine whether magnesium provides analgesic efficacy on par with the established opioid adjuvant.
- Materials and Methods
Seventy-five ASA I–II patients undergoing elective infraumbilical surgeries were randomized into three groups: Control (bupivacaine + saline), M100 (bupivacaine + 100 mg magnesium sulfate), and F (bupivacaine + 25 mcg fentanyl). Spinal anesthesia was administered under standard conditions. Parameters including onset and duration of sensory and motor block, and adverse effects like hypotension and bradycardia, were monitored. Data were analyzed using ANOVA, Chi-square, and posthoc LSD tests. A p-value < 0.05 was considered statistically significant.
4.Results
Group F demonstrated the longest sensory and motor block durations, while M100 showed a faster onset and moderately prolonged duration compared to Control. Control had the shortest block durations. Ephedrine usage, indicative of hypotension, was highest in M100 (32%), followed by F (24%), and none in Control, showing significant hemodynamic impact. Sensory and motor durations across all groups were statistically significant (p < 0.001), suggesting that both adjuvants enhanced block characteristics, with magnesium showing performance comparable to fentanyl.
5.Conclusions
Magnesium sulfate stands on par with fentanyl in prolonging spinal anesthesia, offering comparable block durations with a non-opioid profile. While onset is slower, its efficacy and safety render it a valuable alternative, particularly in patients where opioid use is limited or contraindicated. These findings support magnesium sulfate as a clinically relevant intrathecal adjuvant and justify its further use and study in spinal anesthesia protocols.
References
2. Kathuria B, Luthra N, Gupta A, Grewal A, Sood D. Comparative efficacy of two different dosages of intrathecal magnesium sulphate supplementation in subarachnoid block. J Clin Diagn Res. 2014;8(6):GC01–GC05.
3. Rawal N, Axelsson K, Hylander J, et al. Postoperative patient-controlled local anesthetic administration at home. Anesth Analg. 1998;86(1):86–9.
4. Dahl JB, Jeppensen IS, Jorgensen H, et al. Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing caesarean section with spinal anesthesia: A qualitative and quantitative systematic review of randomized controlled trials. Anesthesiology. 1999;91(6):1919–27.
5. Gehling MH, Tryba M. Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: A meta-analysis. Anaesthesia. 2009;64(6):643–51.
6. 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(3):293–9.
7. Fawcett WJ, Haxby EJ, Male DA. Magnesium: physiology and pharmacology. Br J Anaesth. 1999;83(2):302–20.
8. Brunton LL, Chabner BA, Knollmann BC, editors. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 12th ed. New York: McGraw-Hill; 2011.
9. Ko SH, Lim HR, Kim DC, et al. Magnesium sulphate does not reduce postoperative analgesic requirements. Anesthesiology. 2001;95(3):640–6.
10. Khemakhem K, Mebazaa MS, Ouerghi S, et al. Intrathecal magnesium sulfate reduces postoperative analgesic requirements after cesarean section. Anesth Analg. 2010;111(1):265–8.
11. Buvanendran A, Kroin JS, Tuman KJ, et al. Intrathecal magnesium prolongs fentanyl analgesia: a prospective, randomized, controlled trial. Anesth Analg. 2002;95(3):661–6.
12. Khezri MB, Yaghobi S, Hajikhani M, Asefzadeh S. Comparison of postoperative analgesic effect of intrathecal magnesium and fentanyl added to bupivacaine in patients undergoing lower limb orthopedic surgery. Acta Anaesthesiol Taiwan. 2012;50(1):19–24.
13. Jabalameli M, Pakzadmoghadam SH. Adding different doses of intrathecal magnesium sulfate for spinal anesthesia in the cesarean section: A prospective double blind randomized trial. Adv Biomed Res. 2012;1:7. advbiores.mui.ac.ir
14. Nath MP, Singh AK, Singh D, et al. Comparative evaluation of intrathecal bupivacaine with fentanyl and bupivacaine with magnesium sulfate for cesarean section. J Obstet Anaesth Crit Care. 2014;4(1):23–7.
15. Kamel RK, Al-Rabiey MA, Hassan AA, Sakr TEA. A comparative study of intrathecal dexmedetomidine, fentanyl and magnesium sulphate as adjuvants to 0.5% hyperbaric bupivacaine for lower abdominal surgeries. Benha J Appl Sci. 2021;6(3):143–7.
16. 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 Obstet Anesth. 2010;19(2):161–6.
17. Ozalevli M, Unlugenc H, Tuncer U, et al. Comparison of intrathecal magnesium, fentanyl, or placebo combined with bupivacaine 0.5% for parturients undergoing elective cesarean delivery. Acta Anaesthesiol Scand. 2009;53(3):346–53.
18. Dayioglu H, Baykara ZN, Kocum A, et al. The effect of intrathecal magnesium sulfate on spinal anesthesia. Middle East J Anaesthesiol. 2008;19(2):397–411.
19. Singelyn FJ, Gouverneur JM, Robert A. A minimum dose of intrathecal morphine combined with sufentanil provides satisfactory analgesia after major orthopedic surgery. Anesth Analg. 1999;89(5):1227–30.
20. Entezari A, Gousheh SM, Gousheh MR, et al. Comparison of the effects of intrathecal clonidine and magnesium sulfate on postoperative analgesia in patients undergoing lower limb orthopedic surgery. Anesth Pain Med. 2015;5(1):e22068.
21. Gupta R, Verma R, Bogra J, et al. A comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to bupivacaine. J Anaesthesiol Clin Pharmacol. 2011;27(3):339–43.
22. Brummett CM, Norat MA, Palmisano JM, Lydic R. Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat. Anesthesiology. 2008;109(3):502–11.
23. Lauretti GR, Oliveira R, Reis MP, et al. Study of three different doses of epidural neostigmine coadministered with lidocaine for postoperative analgesia. Anesthesiology. 1999;90(6):1534–8.
24. Wang C, Chakrabarti MK, Whitwam JG. Specific enhancement by fentanyl of the effects of intrathecal bupivacaine on nociceptive afferent but not on sympathetic efferent pathways in dogs. Anesthesiology. 1993;79(4):766–73.
25. Greene NM. Distribution of local anesthetic solutions within the subarachnoid space. Anesth Analg. 1985;64(7):715–30.
26. Morgan GE, Mikhail MS, Murray MJ. Clinical Anesthesiology. 4th ed. New York: Lange Medical Books/McGraw-Hill; 2006.
27. Ryu JH, Sohn IS, Do SH. Intrathecal magnesium sulfate added to bupivacaine prolongs analgesia in patients undergoing total knee arthroplasty. Br J Anaesth. 2009;103(3):429–35.
28. De Oliveira GS Jr, Castro-Alves LJ, McCarthy RJ. Intrathecal magnesium to reduce postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. 2013;119(1):178–90.
29. Collin VJ. Principles of 81naesthesiology. 3rd ed. Philadelphia: Lea and Febiger; 1993.
30. Tetzlaff JE. The pharmacology of local anesthetics. Anesthesiology Clinics of North America. 2000 Jun 1;18(2):217-33.
31. Ropper AH, Samuels MA. Adams and Victor's Principles of Neurology. 9th ed. New York: McGraw-Hill; 2009.
32. Gupta M, Gupta P, Kaushal S. Magnesium sulfate: A versatile drug. Indian J Pharmacol. 2016;48(6):618–622.
33. Altura BM, Altura BT. Association of intracellular magnesium deficiency with cardiovascular diseases and atherogenesis: the pioneering studies of 1990s. Magnes Res. 1999;12(4):273–279.
34. Chien L, O'Brien WF, Elliott JP. Magnesium sulfate: pharmacology, clinical indications, and adverse effects. Obstet Gynecol Surv. 2001;56(1):35–43.
35. Miller RD, Pardo MC. Basics of Anesthesia. 6th ed. Philadelphia: Elsevier Health Sciences; 2011.
36. Fawcett WJ, Haxby EJ, Male DA. Magnesium: physiology and pharmacology. Br J Anaesth. 1999;83(2):302–320.
37. Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2003;27(3):239–246.
38. Rowe BH, Bretzlaff JA, Bourdon C, Camargo CA. Magnesium sulfate for treating exacerbations of acute asthma in the emergency department. Cochrane Database Syst Rev. 2000;(2):CD001490.
39. Altman D, Carroli G, Duley L, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet. 2002;359(9321):1877–1890.
40. Norwitz ER, Repke JT. Pharmacological management of preeclampsia. Clin Obstet Gynecol. 2000;43(1):122–131.
41. Bromage PR. A comparison of the hydrochloride and carbon dioxide salt of lidocaine and prilocaine in epidural analgesia. Acta Anaesthesiologica Scandinavica.1965; Suppl. XVI: 55–69
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Tilak Lokesh*
Junior resident, Post Graduate, Dept of Anaesthesia, SSIMS & RC, Davangere, Rajiv Gandhi University (RGUHS), Karnataka