COMPARATIVE EFFICACY AND SAFETY OF ROPIVACAINE WITH MAGNESIUM SULPHATE AND PLAIN ROPIVACAINE IN ULTRASOUND GUIDED SUPRACLAVICULAR BLOCKS FOR UPPER LIMB SURGERIES.
Main Article Content
Keywords
Analgesia, Magnesium Sulphate, Motor Block, Ropivacaine, Sensory Block.
Abstract
Background: Postoperative pain management is a crucial part of patient care for surgeries involving the upper limbs. A popular technique for providing both postoperative analgesia and regional anaesthesia is a supraclavicular plexus block guided by a peripheral nerve stimulator. Recent research has demonstrated that the analgesic effect of ropivacaine can be enhanced by the addition of magnesium sulphate. Ropivacaine is a piperidinecarboxamide-based amidetype local anaesthetic (amide caine) in which (S)-Npropylpipecolic acid and 2,6-dimethylaniline are combined to form the amide bond.
The aim of the study was to compare the efficacy and safety of addition of magnesium sulfate with Ropivacaine versus plain Ropivacaine under ultrasound guided supraclavicular plexus block for patients undergone upper limb surgeries. It was a randomized prospective study conducted at tertiary Care Hospital - “Prasad Institute of Medical Sciences”, Banthra, Lucknow, UP, India.
A total of 50 patients, aged 18 to 60 years, both sexes were divided randomly by computerized allocated numbers into two equal groups. Group-A received 20 ml of 0.75% Ropivacaine + 0.5 ml (250 mg) Magnesium sulphate whereas Group-B received 20 ml of 0.75% Ropivacaine + 0.5 ml Normal saline. These patients were posted for elective upper limb surgeries. This study was primarily compared the efficacy of supraclavicular plexus block in both the groups in terms of the duration of sensory block and Motor block, quality of analgesia, total duration of analgesia, perioperative hemodynamic, VAS score 0, 2,4,6,12,24 hours and complications.
Result: In group-A, the mean duration of Sensory blockade was 432.82± 8.16 minutes and in group-B was 274.93± 6.43 minutes, the P value was <0.001 and was statistically significant. VAS score at 6 hours in group-A, was 0.86± 0.61 and 1.97± 1.79 in group-B and the P value was <0.001, which was also found statistically significant. The patients those who received Ropivacaine & Magnesium Sulphate (318.32 ± 6.17 min) had significantly longer duration of Motor block than patients who received Ropivacaine alone (239.87 ± 5.98 min). Requirement of first Rescue Analgesia was delayed in group-A (578.16 ±18.72 minutes) as compared to group- B (396.76±21.12 minutes) and the P value was <0.001 and was statistically significant. Perioperative, postoperative hemodynamics was not significant for both the groups.
Conclusion: The addition of magnesium has proved to be a better adjuvant in this study, since it prolonged the duration of sensory and motor blockade significantly. Hence, magnesium sulphate added to Ropivacaine for ultrasound guided supraclavicular plexus block provided better postoperative analgesia and also reduced the requirement of rescue analgesic in postoperative period. Large sample size with multicentric study is required to establish the above results accurately.
References
2. Akhondzade R and Nesioonpour S. The effect of magnesium sulphate on post operative pain in upper limb surgeries by supraclavicular Block under Ultrasound Guidance. Anaesth Pain Med. 2017; 7(3): e14232.
3. Namasivayam P and Namasivayam A. A Randomized controlled study comparing USG guided supraclavicular vs.infraclavicular brachial plexus block for upper limb surgeries. University J of Surg and Surgical Specialities; vol 1 issue 1: 2015.
4. Taneja P., and Singh M. Comparison of 0.5% Ropivacaine with 0.5% Ropivacaine and magnesium sulphate in supraclavicular brachial plexus block for forelimb and hand surgeries. Int J Med Rev 2018; 6 (03) :136-142.
5. Mukherjee K and Das A. Evaluation of magnesium as an adjuvant in ropivacaine-induced supraclavicular brachial plexus block: A Prospective, double-blinded randomized controlled study. J Res Pharm Pract, 2014 ;3(4) 123-129.
6. Verma V and Rana S. A dose-finding randomised controlled trial of magnesium sulphate as an adjuvant in ultrasoundguided supraclavicular brachial plexus block. Indian J Anaesth. 2017; 61: 250-5.
7. Weinstein EJ, Levene JL, Cohen MS, et al.: Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children. Cochrane Database Syst. Rev. 2018; 2019(2): 1–182.
8. Neal JM, Gerancher JC, Hebl JR, et al.: Upper Extremity Regional Anesthesia: Essentials of Our Current Understanding, 2008. Reg. Anesth. Pain Med. 2009; 34(2): 134–170.
9. Abdelfatah M and Elshaer AN. The effect of adding magnesium sulphate to lidocaine in an interscalene plexus block for shoulder arthroscopic acromioplasty. Ain- Shams journal of Anaesthesiology2014, 07:59-64.
10. Gupta P, Gupta K, Dwivedi AN, et al.: Potential role of ultrasound in anesthesia and intensive care. Anesth. Essays Res. 2011; 5(1): 11–19.
11. Deshpande JP, Patil KN. Evaluation of magnesium as an adjuvant to ropivacaine-induced axillary brachial plexus block: A prospective, randomised, double-blind study. Indian journal of anaesthesia, 2020;64(4):310–5.
12. Ramsay MAE: Acute Postoperative Pain Management. Baylor Univ. Med. Cent. Proc. 2000; 13(3): 244–247.
13. Swain A, Nag DS, Sahu S, et al.: Adjuvants to local anesthetics: Current understanding and future trends. World J. Clin. Cases. 2017; 5(8): 307–323.
14. Telci L, Esen F, Akcora D, et al.: Evaluation of effects of magnesium sulphate in reducing intraoperative anaesthetic requirements. Br. J. Anaesth. 2002 Oct; 89(4): 594–598.
15. Gupta D, Mangal V, Kulshestha A, et al.: Efficacy of Magnesium Sulfate as Adjuvant to Ropivacaine 0.4% for Supraclavicular Brachial Plexus Block in Patients undergoing Upper Limb Surgery: A Randomized Controlled Trial. J. Recent Adv. Pain. 2017; 3(2): 85–89.
16. Krishna Prasad G, Khanna S, Jaishree S: Review of adjuvants to local anesthetics in peripheral nerve blocks: Current and future trends. Saudi J. Anaesth. 2023; 14(1): 77–84.
17. Shridevi J, Asokan A: Comparison of ropivacaine with magnesium sulphate and plain ropivacaine in ultrasound guided supraclavicular blocks for upper limb surgeries. Indian J. Clin. Anaesth. 2020; 7(2): 203–206.
18. Kaur S, Dhawan J, Gupta R, et al.: Comparison of magnesium sulfate and ketamine with ropivacaine in supraclavicular brachial plexus block: A randomized controlled trial. Anesth. Essays Res. 2020; 14(1): 143–148.
19. Shukla U, Singh D, Yadav JBS, et al.: Dexmedetomidine and magnesium sulfate as adjuvant to 0.5% ropivacaine in supraclavicular brachial plexus block: A comparative evaluation. Anesth. Essays Res. 2020; 14(4): 572–577.
20. Chadha M, Si S, Bhatt D, et al.: The comparison of two different volumes of 0.5% ropivacaine in ultrasound-guided supraclavicular brachial plexus block onset and duration of analgesia for upper limb surgery: A randomized controlled study. Anesth. Essays Res. 2020; 14(1): 87–91.
21. Kumari P, Singh RB, Saurabh K, et al.: To compare the efficacy of postoperative analgesia between clonidine and dexmedetomidine as adjuvants with 0.5% ropivacaine by ultrasound-guided supraclavicular brachial plexus block for upper limb surgeries: A prospective, double-blind, randomized study. Anesth. Essays Res. 2020; 14(4): 644–652.
22. Karthik G.S., Sudheer R., S. Rangalakshmi, Priyanka N.P., Prajwal B.V. Magnesium Sulphate as an Adjuvant to Ropivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block: A Comparative Prospective Randomized Controlled Study. Indian J Anesth Analg 2018; 5(7): 1093-1100.
23. Connor, Nick (24 July 2023). "Magnesium Sulfate | Formula, Properties & Application" (https:// material-properties.org/magnesium-sulfate/). Material Properties. Retrieved 4 February 2024.
24. Das A, Dutta S, Mandal P, Mukherjee K, Mukherjee A, Basunia SR. Evaluation of Magnesium as an adjuvant in Ropivacaine-induced supraclavicular brachial plexus block: A prospective, double-blinded randomized controlled study. J Res Pharm Pract. 2014;3(4):123–9.
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 YOGENDRA PRATAP MAURYA
Assistant Professor, Department of Anesthesiology, Prasad Institute of Medical Sciences, Junab Ganj, Sarai Sahjadi, Banthra, Lucknow, Uttar Pradesh, India.
DR PRAVIN SINGH THAKUR
Assistant Professor, Department of Anesthesiology, Prasad Institute of Medical Sciences, Junab Ganj, Sarai Sahjadi, Banthra, Lucknow, Uttar Pradesh, India.
DR RAJEEV KUMAR
Assistant Professor, Department of Anesthesiology, Prasad Institute of Medical Sciences, Junab Ganj, Sarai Sahjadi, Banthra, Lucknow, Uttar Pradesh, India.