Effect of Adding Magnesium Sulphate to Epidural Bupivacaine Compared to Addition of Fentanyl in Patients undergoing Lower Limb Orthopedic Surgery under Combined Spinal Epidural Anathesia

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Ibrahim El-Desoukey Mohamed ◽  
Sahar Mohammed Kamal Mahmoud ◽  
Kareem Youssef Kamal
Keyword(s):  
Orthopedic Surgery ◽  
Magnesium Sulphate ◽  
Lower Limb ◽  
The Other ◽  
Sulphate Group ◽  
Sensory Blockade ◽  
Combined Spinal Epidural ◽  
Epidural Bupivacaine ◽  
Spinal Epidural ◽  
Fentanyl Group

Abstract Background The use of opioids in intrathecal or epidural anesthesia has become popular to optimize postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use. Objectives The purpose of this study was to assess the postoperative analgesic requirements and the analgesic effect of adding magnesium sulphate to epidural bupivacaine compared to addition of fentanyl in patients undergoing lower limb orthopedic surgery under combined spinal epidural anathesia. Patients and Methods After approval of ethical committee in our study and obtaining written informed consent from eligible patients the study was conducted on 60 patients classified to ASA I and II scheduled for lower limb orthopedic surgery. The study presents double armed randomized interventional prospective study including patients allocated into two equal groups each consists of 30 patients. Group (A): patients received magnesium sulphate added to bupivacaine in epidural, Group (B): patients received fentanyl added to bupivacaine in epidural Results The results of their study showed that the maximum level of sensory blockade was significantly higher in the combined fentanyl with magnesium group as compared with fentanyl group alone and magnesium sulphate group alone. The duration of sensory blockade of the combined fentanyl and magnesium group was significantly prolonged as compared to the other two groups as for the other two group the difference in the blockade duration was insignificant Conclusion We concluded that either magnesium sulfate (75 mg) combined with (10 ml) 0.25% Bupivacaine or fentanyl (1 µg/kg) combined with (10 ml) 0.25% Bupivacaine in combined spinal epidural improves intraoperative analgesia and prolongs early postoperative analgesia in lower limb orthopedic surgeries. The duration of analgesia was more prolonged in magnesium sulphate group than in the fentanyl group and this difference was statistically significant.

scholarly journals Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: prospective randomized study

2009 ◽  
Vol 127 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Luiz Eduardo Imbelloni ◽  
Marildo Assunção Gouveia ◽  
José Antonio Cordeiro
Keyword(s):  
Clinical Study ◽  
Spinal Anesthesia ◽  
Orthopedic Surgery ◽  
Motor Blockade ◽  
Continuous Spinal Anesthesia ◽  
Sensory Blockade ◽  
Combined Spinal Epidural ◽  
Major Orthopedic Surgery ◽  
Spinal Epidural ◽  
Blockade Level

CONTEXT AND OBJECTIVES: In major orthopedic surgery of the lower limbs, continuous spinal anesthesia (CSA) and combined spinal epidural anesthesia (CSE) are safe and reliable anesthesia methods. In this prospective randomized clinical study, the blockading properties and side effects of CSA were compared with single interspace CSE, among patients scheduled for major hip or knee surgery. DESIGN AND SETTING: Prospective clinical study conducted at the Institute for Regional Anesthesia, Hospital de Base, São José do Rio Preto. METHODS: 240 patients scheduled for hip arthroplasty, knee arthroplasty or femoral fracture treatment were randomly assigned to receive either CSA or CSE. Blockades were performed in the lateral position at the L3-L4 interspace. Puncture success, technical difficulties, paresthesia, highest level of sensory and motor blockade, need for complementary doses of local anesthetic, degree of technical difficulties, cardiocirculatory changes and postdural puncture headache (PDPH) were recorded. At the end of the surgery, the catheter was removed and cerebrospinal fluid leakage was evaluated. RESULTS: Seven patients were excluded (three CSA and four CSE). There was significantly lower incidence of paresthesia in the CSE group. The resultant sensory blockade level was significantly higher with CSE. Complete motor blockade occurred in 110 CSA patients and in 109 CSE patients. Arterial hypotension was observed significantly more often in the CSE group. PDPH was observed in two patients of each group. CONCLUSION: Our results suggest that both CSA and CSE provided good surgical conditions with low incidence of complications. The sensory blockade level and hemodynamic changes were lower with CSA.

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

2018 ◽  
Vol 6 (4) ◽  
pp. 1258
Author(s):  
Deepak Sharma ◽  
Daljit Kaur ◽  
Bilal Ahmad ◽  
Abhishek Kumar ◽  
Divya Agarwal
Keyword(s):  
Magnesium Sulphate ◽  
Hip Replacement ◽  
Calcium Influx ◽  
Epidural Fentanyl ◽  
Subarachnoid Block ◽  
Combined Spinal Epidural ◽  
Group I ◽  
Significant Difference ◽  
Spinal Epidural ◽  
Fentanyl Group

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. 

scholarly journals Combined spinal‐epidural versus spinal anesthesia comparison of efficacy in terms of analgesia and motor and sensory blockade

2021 ◽  
Vol 8 (4) ◽  
pp. 580
Author(s):  
Akif Mutahar Shah ◽  
Aliya Shah ◽  
Safura Riaz ◽  
Muzzafar Zaman
Keyword(s):  
Epidural Anesthesia ◽  
Lower Limb ◽  
Medical Literature ◽  
Trauma Surgery ◽  
Gynecological Surgery ◽  
Medical Sciences ◽  
Sensory Blockade ◽  
Combined Spinal Epidural ◽  
Spinal Epidural ◽  
Combined Technique

Background: This study was conducted on patients to compare efficacy in terms of motor and sensory blockade and prolonged time of analgesia between spinal and combined spinal epidural methods of anesthesia.Methods: This prospective study was conducted on 60 adult patients of either sex belonging to ASA grade I and II, from June 2014 to June 2016 at Maharishi Markendeshwar institute of medical sciences and research, Mullana in the department of anesthesia.Results: The patients were randomly allocated into two groups of 30 each as defined in text, by a computer-generated number. Proper statistical methods were applied and results obtained. results were statistically significant p<0.05.Conclusions: The Combined spinal epidural technique has been described in the medical literature for use in general surgery, orthopedics, trauma surgery of a lower limb, and urological and gynecological surgery. With this technique, surgical anesthesia is established rapidly, saving 15-20 minutes compared with epidural anesthesia. Patients who received the combined technique had more intense motor blockade than those who received epidural anesthesia alone.

scholarly journals Comparing the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam or Magnesium Sulphate Combination in Patients Undergoing Elective Infraumbilical Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Josef Attia ◽  
Amany Abo Elhussien ◽  
Mostafa Zaki
Keyword(s):  
Side Effects ◽  
Magnesium Sulphate ◽  
Lower Limb ◽  
Analgesic Efficacy ◽  
Motor Blockade ◽  
Sensory Blockade ◽  
Lower Limb Surgery ◽  
Group A ◽  
Group B ◽  
Limited Duration

Background. Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia. Aim of the Work. The aim of this study was to decrease bupivacaine dose used in spinal anesthesia in patients undergoing orthopedic lower limb surgery and reduce its possible side effects. Patient and Methods. Sixty adult patients of both sexes, divided into three. Group C received 2.5 mL bupivacaine and 0.5 mL saline 0.9%. Group A received 2.5 mL bupivacaine and 0.5 mL midazolam. Group B received 2.5 mL bupivacaine and 0.5 mL magnesium sulphate. Results. As regards onset of both motor and sensory blockade, there are a significant decrease in group A and a significant increase in group B as compared to group C, with a significant decrease in duration of motor blockade and significant increase in duration of sensory blockade in both group A and group B, respectively, as compared to group C, with a significant decrease in the duration of sensory blockade in group B as compared to group C. Conclusions. These results suggested that intrathecal midazolam as an adjuvant for bupivacaine increases the duration of both sensory and motor blockade more than that of magnesium sulphate.

Combined spinal/epidural bupivacaine/sufentanil for labour analgesia

1997 ◽  
Vol 14 (5) ◽  
pp. 536
Author(s):  
I. SMILOV ◽  
I. KOVACHEV ◽  
M. SREBREVA ◽  
D. SHOUPERLIEVA
Keyword(s):  
Labour Analgesia ◽  
Combined Spinal Epidural ◽  
Epidural Bupivacaine ◽  
Spinal Epidural
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