scholarly journals Efficacy and Safety of Magnesium versus Dexmedetomidine as Additives to Local Anesthetic Mixture Using Single Injection Percutaneous Peribulbar Anesthesia in Vitreoretinal Surgeries

2018 ◽  
Vol 12 (1) ◽  
pp. 94-100
Author(s):  
Aktham Shoukry ◽  
Amr Sobhy Abd el Kawy
Keyword(s):  
Local Anesthetic ◽  
Normal Saline ◽  
Magnesium Sulphate ◽  
Motor Block ◽  
Vitreoretinal Surgery ◽  
Control Group ◽  
Peribulbar Block ◽  
Ocular Pressure ◽  
Peribulbar Anesthesia ◽  
Group D

Background: Peribulbar block for vitreoretinal surgery is rather associated with delayed onset of globe anesthesia, akinesia and short duration of analgesia. Objective: To compare the effect of addition of Magnesium sulphate vs dexmedetomidine to standard local anesthetics mixtures on the time of onset of Globe Anesthesia, Akinesia & analgesia duration. Patients and Methods: Ninety patients of both sexes, aged 25- 75 years, ASA I-III scheduled for vitreoretinal surgery. They were randomly allocated into 3 equal groups each received peribulbar block a mixture of Levo- bupivacaine 0.5% (3 ml) + lidocaine 2% (3 ml) +120 IU hyaluronidase + Control group (C): 0.5 ml of Normal saline. Group (M): 50 mg of Magnesium sulphate in 0.5 ml normal saline. Group (D): 50 μic of dexmedetomidine in 0.5 ml normal saline. The duration of sensory, motor block, Sedation level, Intra-ocular Pressure (IOP) and surgeon satisfaction were assessed. Results: The onset of globe anesthesia and akinesia was significantly shorter in M group in comparison with D and C Groups, with a significant increase in the duration of globe analgesia and akinesia in the D Group when compared to both M & C groups. Groups D and M showed a statistically significant decrease in the IOP at 5 min and 10 min when compared to the baseline measurement of the same groups & to C Group, no complications or adverse effects related to the drug or technique were recorded. Conclusion: Magnesium sulphate as a local anesthetic adjuvant in peribulbar block is safe and comparable to dexmedetomidine regarding the sensory and motor block duration with better cost-effectiveness and availability.

scholarly journals Dexmedetomidine was Better at Lowering Intraocular Pressure than Magnesium when Combined with Local Anesthetics in Peribulbar Blocks for Posterior Segment Eye Surgery

2018 ◽  
Vol 12 (1) ◽  
pp. 42-48
Author(s):  
Dalia Ahmed Ibrahim ◽  
Dina Salah
Keyword(s):  
Intraocular Pressure ◽  
Local Anesthetic ◽  
Normal Saline ◽  
Local Anesthetics ◽  
Posterior Segment ◽  
The Other ◽  
Controlled Clinical Trial ◽  
Peribulbar Block ◽  
Analgesic Dose ◽  
Group D

Background and Aim: Many medications are combined with local anesthetics for peribulbar blocks to improve the quality of the block, however, few studies have compared the effect of dexmedetomidine and magnesium on intraocular pressure when combined with local anesthetics which was the primary endpoint of this double blinded study. Materials and Methods: A randomized controlled clinical trial was conducted on 60 ASA Physical Status (ASA PS) I-II patients scheduled for elective posterior segment eye surgeries under peribulbar anesthesia. Patients were randomly allocated to one of three groups of 20 each according to the medications they received. Local anesthetic solution was prepared using 8 ml of bupivacaine 0.5% and lidocaine 2% in a 1: 1 ratio plus 1ml of hyaluronidase (150 units) making a total volume of 9 ml: Group D received: local anesthetic + 20 µg dexmedetomidine diluted with 1 mL of normal saline. Group M received: local anesthetic + magnesium sulphate 50 mg in 1 ml normal saline. Group C received local anesthetic + 1 ml normal saline. Intraocular pressure was measured with the Perkins applanation tonometer immediately before injection and at 1, 5, 10, 15 minutes (min) after injection and then at the end of the procedure, the onset and duration of lid and globe akinesia were assessed. Postoperative analgesia and the first dose of analgesic medication were also assessed. Results: Intraocular pressure measurements were statistically lower in group D than the other two groups at 10 and 15mins. The onset of globe and lid akinesia was the most rapid in Group D compared to the other two groups. The duration of globe and lid akinesia was the longest in group D. Time to first analgesic dose request was significantly longer in group D followed by group M then group C. Visual analogue score for pain was significantly less between group D and other two groups. There were no episodes of hypotension or bradycardia in the three groups. No side effects or complications as hemorrhage, globe perforation, brain stem anesthesia sedation were observed. Conclusion: In our study addition of dexmedetomidine to a peribulbar block was statistically better at reducing IOP, increasing the duration of optic anesthesia and delaying the need for postoperative analgesic dose request than magnesium.

scholarly journals A COMPARATIVE STUDY OF INTRATHECAL BUPIVACAINEHEAVY (0.5%) WITH BUPIVACAINE HEAVY (0.5%) PLUS DEXMEDETOMIDINE FOR LOWER ABDOMINAL SURGERIES

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Kumar Shailesh ◽  
Jitendra Prasad Singh ◽  
Arjun Prasad ◽  
Veena Horo
Keyword(s):  
Side Effects ◽  
Normal Saline ◽  
Motor Block ◽  
Onset Time ◽  
Local Anaesthetics ◽  
Control Group ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
High Doses ◽  
Group D

Introduction: Several adjuncts like adrenaline, opioids and alpha-2 adrenergic agonists are being used with local anaesthetics intrathecally for prolongation of intra-operative and post-operative analgesia and to reduce the side-effects of high doses of local anaesthetics. Aim: The present study was done to evaluate the onset and duration of sensory and motor block, hemodynamic effects, post-operative analgesia and adverse effects of Dexmedetomidine given intrathecally with hyperbaric 0.5% Bupivacaine. Materials and methods: Sixty inpatients of ASA class I and II scheduled for various lower abdominal surgeries under Sub-Arachnoid Block were randomly divided into two groups of 30 each namely C (Control), D(Dexmedetomidine) . All received 12.5mg hyperbaric bupivacaine plus 0.5 ml Normal Saline in Group C (Control),10µg Dexmedetomidine (diluted in preservative free Normal saline of 0.5ml) in Group D(Dexmedetomidine) . The onset time to reach peak sensory and motor level, the regression time for sensory and motor block, hemodynamic changes and side-effects were noted. Results: The duration of sensory and motor block, rescue analgesia was significantly prolonged in Dexmedetomidine group when compared to that of Control group. Conclusion: Dexmedetomidine 10 µg seems to be a better neuraxial adjuvant to hyperbaric Bupivacaine. Keywords: Bupivacaine; Dexmedetomidine; intrathecal.

scholarly journals Comparing Intravenous Single Low Doses of Magnesium Sulphate versus Dexamethasone as Adjuvants to Ultrasound Guided Transversus Abdominis Plane (TAP) Block for Prolongation of Postcesarean Analgesia

2021 ◽  
Vol 15 (1) ◽  
pp. 22-29
Author(s):  
Tamer N. Abdelrahman ◽  
Rasha G. Abu-Sinna
Keyword(s):  
Magnesium Sulphate ◽  
Transversus Abdominis ◽  
Anesthetic Technique ◽  
Control Group ◽  
Time Interval ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Rescue Analgesia ◽  
Group D

Introduction: The TAP block is a regional anesthetic technique, which blocks neural afferents between T6 and L1, which provide anterior abdominal walls and therefore help to alleviate postoperative pain. Aim: The aim is to compare the efficacy of preoperative single low dose of intravenous MgSO4 versus intravenous dexamethasone as adjuvants to ultrasound guided TAP block for prolongation of postcesaren analgesia. Materials and Methods: A total 60 pregnant females were selected undergoing elective caesarean sections under general anesthesia with ultrasound-guided transversus abdominis plane (TAP) block done at the end of surgery. Patients were randomly and equally allocated into three groups of 20 patients each. The first group of patients were classified as magnesium sulphate group (M)who received 50 mg/Kg IV, the second group of patients were classified as dexamethasone group (D) who received 2 mg IV and the third group was classified as the placebo group (C) who received IV saline. Results: Comparison of the VAS at 6 and 12 hours postoperatively showed statistically significantly lower values in group (M) and group (D) compared to group (C) and also group (M) was significantly lower than group (D) as well. The time interval until first rescue analgesia (Nalbuphine) needed by the patients (VAS ≥ 50) was significantly longer in group (M) compared to group (D) and group (C) consecutively. Additionally, it was significantly longer in group (D) than in the control group(C). The total dose of rescue analgesia consumed during the first 24 hours postoperatively was significantly lower in groups (M) than in group (D) and both groups showed lesser doses compared to group (C) Conclusion: We concluded that both MgSO4 and dexamethasone could prolong the postoperative duration and analgesic efficiency provided by the TAP block in cesarean sections. This further reduced the demands for postoperative rescue analgesia, with MgSO4 found to be more efficient than IV dexamethasone. Clinical Trial Registration Number: NCT04223128

scholarly journals Evaluating the effect of dexmedetomidine premedication on the quality of subarachnoid block, haemodynamics and sedation in patients undergoing lower limb surgeries: a prospective randomized controlled trial

2017 ◽  
Vol 5 (12) ◽  
pp. 5410
Author(s):  
Sandeep Sharma ◽  
Mahesh Somani ◽  
Madhan Chandramohan ◽  
Lalit Kumar Raiger
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Diastolic Blood Pressure ◽  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Motor Block ◽  
Control Group ◽  
Sensory Blockade ◽  
Group D

Background: Present study was designed to evaluate the effect of intravenous dexmedetomidine on haemodynamics, sedation and quality of spinal anaesthesia with 0.5% hyperbaric bupivacaine.Methods: Sixty ASA grade 1 and 2, 18-60 years aged patients scheduled for elective lower limb surgeries were randomly divided into two groups: Group C (Control) and Group D (Study), received intravenous normal saline 10ml and intravenous dexmedetomidine 1μg/kg in dilution of 10ml respectively over 10minutes duration, 10minutes before subarachnoid block with 2.5ml of 0.5% hyperbaric bupivacaine. The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), quality of sensory and motor block and level of sedation were monitored intraoperatively and postoperatively.Results: The heart rate was statistically significantly decreased in group D both intraoperatively and postoperatively. Intraoperative and postoperative SBP and DBP were lower in dexmedetomidine group but clinically that was insignificant. Intraoperative Ramsay sedation scores were significantly higher in dexmedetomidine group (3.49±0.240) as compared to control group (2.51±0.249) (p<0.001) but the patients were easily arousable. The duration of sensory blockade (208.83±9.53 min vs 162.83±9.62 min), duration for 2 dermatomal regression of sensory blockade (146.5±10.013min vs 98±8.57min) and the duration for motor block regression to Modified Bromage scale 0 (167.33±10.5min vs 137.83±11.94min) were significantly prolonged in dexmedetomidine group as compared to control group. The highest level of sensory blockade was also significantly higher in dexmedetomidine group (T6.90±0.759 vs T7.60±0.621). There was no difference in the time for attaining highest level of sensory blockade, time taken for motor blockade to reach Modified Bromage Scale 3 between both the groups. Average 24hr mean VAS score was significantly lower in dexmedetomidine group (1.37±0.15 vs1.72±0.17, p<0.001). Time to first request for rescue analgesic was also significantly longer in dexmedetomidine group (mean 174.33min vs 143.5min). Average 24hour consumption of tramadol analgesic was significantly higher in control group as compared to dexmedetomidine group (391.86±111.62mg vs 279.86±80.55mg, p<0.001).Conclusions: Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anaesthesia. It provides excellent sedation and analgesia. Dexmedetomidine induced decrease in heart rate, systolic/diastolic blood pressure are not clinically significant. 

scholarly journals Fentanyl versus midazolam as additive to local anesthetic mixture for peribulbar block during posterior segment surgery in adult patients a prospective randomized double-blind study

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Ahmed Abdalla Mohamed ◽  
Tamer Fayez Safan
Keyword(s):  
Postoperative Analgesia ◽  
Local Anesthetic ◽  
Posterior Segment ◽  
Adult Patients ◽  
The Other ◽  
Control Group ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Number Of Patients ◽  
Peribulbar Block

Abstract Objectives To evaluate analgesic and hemodynamic outcome of fentanyl or midazolam as additives to local anesthetic mixture (LAM) for peribulbar block (PBB) during posterior chamber surgery. Methods One hundred thirty-two ASA status I to III adult patients aged 50–75 years scheduled for posterior segment surgery (intraocular foreign body and elective vitrectomy) were enrolled in this prospective, randomized, double-blind trial from which 12 patients were excluded. After signing a written fully informed consent for study participation, patients were grouped into 3 groups (40 patients in each group); group C received local anesthetic mixture plus 1 ml plain saline, group F received local anesthetic mixture plus 25 μg fentanyl in 1 ml saline and group M received local anesthetic mixture plus 1 mg midazolam in 1 ml saline. The primary outcome was the onset time of eyelid and globe akinesia. Also, the duration of the block was assessed in the three studied groups. Intraoperative and postoperative hemodynamic measures were assessed. Postoperative analgesia was hourly-assessed using Visual analogue scale (VAS) and rescue analgesia was provided at visual analogue score of > 3. Results The number of patients who had fast eyelid and globe akinesia was significantly higher with significantly lower total 15-min score in group F than the other groups. Intraoperative and postoperative hemodynamic measures were non-significantly different between studied groups. Duration of the block was significantly longer in groups F and M than group C with significantly longer duration in group F. The number of patients who required postoperative rescue analgesia was significantly lower with significantly lower number of requests in group F than the other groups. Conclusion Additives to local anesthetic mixture during peribulbar block provided satisfactory anesthetic outcome than local anesthetic mixture alone. Fentanyl was superior to midazolam in terms of significantly speed up onset, longer block duration with significantly longer postoperative analgesia and lesser consumption of rescue analgesia. Both additives provided adjusted hemodynamic measures comparable to the control group. Trial registration Pan African Clinical Trials Registry (PACTR201708002496243) registered 03/08/2017 retrospectively.

scholarly journals Evaluation of the Efficacy of Magnesium Sulphate as an Adjuvant to Lignocaine for Intravenous Regional Anaesthesia for Upper Limb Surgery

2008 ◽  
Vol 36 (6) ◽  
pp. 840-844 ◽  
Author(s):  
S. Narang ◽  
J. S. Dali ◽  
M. Agarwal ◽  
R. Garg
Keyword(s):  
Upper Limb ◽  
Normal Saline ◽  
Magnesium Sulphate ◽  
Regional Anaesthesia ◽  
Motor Block ◽  
Sensory Block ◽  
Tourniquet Pain ◽  
Upper Limb Surgery ◽  
Significant Difference ◽  
Intravenous Regional Anaesthesia

Several additives have been combined with local anaesthetics for intravenous regional anaesthesia to improve block quality, analgesia and to decrease tourniquet pain. Magnesium sulphate is one potential additive. This prospective, randomised, double-blinded study was conducted in 30 ASA physical status I or II patients undergoing upper limb surgery under tourniquet. In group L, patients received intravenous regional anaesthesia with lignocaine alone (9 ml of 2% lignocaine diluted with normal saline to total volume of 36 ml). Patients in group M received intravenous regional anaesthesia with lignocaine plus magnesium sulphate (6 ml of 25% magnesium sulphate plus 9 ml of 2% lignocaine diluted with normal saline to total volume of 36 ml). Assessment was by observing the response to injection of drug; sensory and motor block and tourniquet pain. The mean time of onset of sensory block was 12.40 and 3.47 minutes in groups L and M respectively (P <0.001). The average times of onset of motor block in groups L and M were 17 and six minutes respectively (P <0.001). Of the patients in group M, 66.7% reported moderate to severe pain while the drug was being injected, compared to 20% in group L (P=0.011). There was a statistically significant difference in visual analogue scale for tourniquet pain at 10 and 30 minutes after tourniquet inflation (lower in group M). These findings indicate that magnesium sulphate added as an adjuvant to lignocaine hastens the onset of sensory and motor block and decreases tourniquet pain. However, there is increased incidence of transient pain on injection if magnesium sulphate is added.

Effect of addition of clonidine to local anesthetic mixture for peribulbar block in vitreoretinal surgery

2007 ◽  
Vol 32 (Suppl. 1) ◽  
pp. 22
Author(s):  
V. Yazbek-karam ◽  
D. Barakat ◽  
E. Abi nader ◽  
H. Karam ◽  
E. Habib ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Vitreoretinal Surgery ◽  
Peribulbar Block

scholarly journals Magnesium sulfate decreases the dose of rocuronium for satisfactory double lumen tube placement condition in patients with myasthenia gravis

2019 ◽  
Author(s):  
Shoujun Fei ◽  
Hengfu Xia ◽  
Xiaowei Chen ◽  
Dazhi Pang ◽  
Xuebing Xu
Keyword(s):  
Myasthenia Gravis ◽  
Magnesium Sulfate ◽  
Normal Saline ◽  
Magnesium Sulphate ◽  
Double Lumen Tube ◽  
Control Group ◽  
Sulphate Group ◽  
Double Lumen ◽  
Lumen Tube ◽  
Intubation Condition

Abstract Background: Titrating a low dose of non-depolarizing neuromuscular blockers for induction of general anesthesia for patients with myasthenia gravis (MG) is a popular accepted practice. This practice may confront with unsatisfactory intubation conditions, especially for double lumen tube (DLT). This double-blind randomised study was to investigate whether magnesium sulfate could decrease the rocuronium demand and improve the DLT placement conditions for MG patients who scheduled for video-assisted thoracoscopic (VATS) thymectomy. Methods: The patients were randomly assigned into the magnesium sulfate or normal saline group. After acquiring the adequate sedative depth, magnesium sulfate(60mg.kg-1) or normal saline(control) was given to the patients in two groups respectively. After that, the same Train of Four (TOF) value was obtained with one or more doses of 0.05 mg.kg-1 rocuronium with 3 minutes interval, then DLT was intubated. The primary and secondary observational outcomes were the cumulative rocuronium dose and the intubation condition for DLT placement respectively. Results: 23 patients in the magnesium sulphate group and 22 patients in the control group completed the study. The amount of rocuronium used to meet the setting value of TOF were 0.10 (0.05)mg.kg-1 and 0.28(0.17) mg.kg-1 in the magnesium sulphate and control group respectively (P<0.0001). Under a similar depth of neuromuscular blockade and sedation, 23 patients in magnesium sulphate group and 16 patients in control group showed excellent intubation condition. The patients in both groups showed similar characteristics of recovery from neuromuscular blockade. Conclusions: Our research showed that magnesium sulfate could decrease the rocuronium demand for satisfactory DLT intubation condition in MG patients.

scholarly journals Effectiveness and Safety of Single Percutaneous Peribulbar Block Using Magnesium Sulphate as an Adjuvant to Local Anesthetics Versus the Standard Peribulbar Block for Strabismus Surgery in Adults

2019 ◽  
Vol 13 (1) ◽  
pp. 100-105 ◽  
Author(s):  
Norhan Aly Sherif ◽  
Mayada Khairy Mohamad ◽  
Sameh Galal Taher ◽  
Ahmed Abdou Hannon ◽  
Hesham Mohamed Salem
Keyword(s):  
Magnesium Sulphate ◽  
Local Anesthetics ◽  
Strabismus Surgery ◽  
Patient’S Satisfaction ◽  
Group I ◽  
Peribulbar Block ◽  
Peribulbar Anesthesia ◽  
Adult Strabismus ◽  
Group Ii

Background: Peribulbar anesthesia in ophthalmic surgeries is limited by delayed and/or incomplete orbital akinesia and inadequate operative and postoperative analgesia. Objective: The aim of this study was to assess the safety and effectiveness of a single percutaneous peribulbar block technique with 100 mg magnesium sulphate added to the local anesthetics used compared with the standard peribulbar block technique in adult strabismus surgery. Methods: A total of 54 consecutive patients undergoing strabismus surgery were included in the study. They were divided into two equal groups (27 patients each). In group I, 1 ml (100 mg/ml) magnesium sulphate added to a mixture of 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered through a single percutaneous peribulbar injection with a short (1 inch) needle, while in group II, a mixture of 1 ml saline added to 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered using the standard peribulbar block technique. The collected data included patient's baseline characteristics, perioperative and early postoperative outcomes and follow-up data. Results: The elapsed time before the onset of anesthesia and akinesia of the globe was significantly shorter in group I compared with group II (1.9 ± 0.7 vs. 3.9 ± 1.0 min, p < 0.001; 2.3 ± 0.7 vs. 4.4 ± 1.2 min, p < 0.001 respectively), and the duration of anesthesia was significantly longer in group I compared with group II (180.0 ± 0.0 vs. 43.0 ± 8.5 min, p < 0.001). The median VAS pain score was significantly lower in group I compared with group II (1.0 vs. 4.0, p < 0.001), and the patient's satisfaction was significantly higher in group I compared with group II (100.0% vs. 25.9%, p < 0.001). Conclusion: Co-administration of 100 mg magnesium sulphate with the local anesthetics was effective and safe. It achieved suitable conditions to start surgery rapidly. Further, it improved the quality of operative conditions and patient satisfaction.

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