Magnesium sulfate at two different doses as an adjuvant to bupivacaine in infraumblical (below knee) orthopedic surgeries under spinal anesthesia

Abstract Background Norepinephrine has been investigated as a potential alterative to phenylephrine for maintaining blood pressure during spinal anesthesia for cesarean delivery with the advantage of less depression of maternal heart rate and cardiac output. However, the relative potencies of these two vasopressors have not been fully determined in this context. Methods In a random-allocation, graded dose–response study, 180 healthy patients undergoing spinal anesthesia for elective cesarean delivery received a single bolus of norepinephrine in one of six different doses ranging from 4 to 12 µg or phenylephrine in one of six different doses ranging from 60 to 200 µg to treat the first episode of hypotension. The magnitude of response was measured as the percentage of full restoration of systolic blood pressure to the baseline value. Dose–response analysis was performed using nonlinear regression to derive four-parameter logistic dose–response curves, which were compared to determine relative potency. Results Data were analyzed for 180 patients. The estimated ED50 values (dose giving a 50% response) were norepinephrine 10 µg (95% CI, 6 to 17 µg) and phenylephrine 137 µg (95% CI, 79 to 236 µg). The estimated relative potency ratio for the two drugs was 13.1 µg (95% CI, 10.4 to 15.8 µg). Conclusions Comparative dose–response analysis was completed for norepinephrine and phenylephrine given as a bolus to treat the first episode of hypotension in patients undergoing spinal anesthesia for cesarean delivery. The estimated dose equivalent to phenylephrine 100 µg was norepinephrine 8 µg (95% CI, 6 to 10 µg). These results may be useful to inform the design of future comparative studies.

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The Additional Effect of Magnesium Sulfate to Lidocaine in Spinal Anesthesia for Cesarean Section

International Journal of Pharmacology ◽

10.3923/ijp.2007.425.427 ◽

2007 ◽

Vol 3 (5) ◽

pp. 425-427 ◽

Cited By ~ 14

Author(s):

M.D. Gita Shoeibi ◽

M.D. Mustafa Sadegi ◽

M.D. Abolfazl Firozian ◽

M.D. Farzaneh Tabassomi

Keyword(s):

Cesarean Section ◽

Magnesium Sulfate ◽

Spinal Anesthesia

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Comparing the efficacy of different doses of intrathecal dexmedetomidine on hemodynamic parameters and block characteristics with ropivacaine spinal anesthesia for cesarean section: A double-blind, randomized clinical trial

The Indian Anaesthetists Forum ◽

10.4103/theiaforum.theiaforum_41_19 ◽

2020 ◽

Vol 21 (1) ◽

pp. 16

Author(s):

Bijan Yazdi ◽

Hesameddin Modir ◽

Maryam Shokrpour ◽

Rasoul Hesamamini ◽

Arghavan Modir ◽

...

Keyword(s):

Clinical Trial ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Randomized Clinical Trial ◽

Hemodynamic Parameters ◽

Double Blind ◽

Different Doses

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Dexmedetomidine versus magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia: a meta-analysis of randomized controlled trials

Journal of International Medical Research ◽

10.1177/0300060520946171 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052094617

Author(s):

Jinguo Wang ◽

Zaitang Wang ◽

Xuesong Song ◽

Na Wang

Keyword(s):

Randomized Controlled Trials ◽

Magnesium Sulfate ◽

Spinal Anesthesia ◽

Local Anesthetics ◽

Sensory Block ◽

Cochrane Library ◽

Controlled Trials ◽

Sensory Blockade ◽

Randomized Controlled ◽

Significant Difference

Objective To compare the efficacy of dexmedetomidine and magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia. Methods A search of PubMed, Medline, Embase, the Cochrane Library, and Google Scholar was performed. Randomized controlled trials comparing the efficacy of dexmedetomidine and magnesium sulfate as a local anesthetic adjuvant in spinal anesthesia were identified. The primary outcome was sensory block duration. The mean difference (MD) or odds ratio along with the 95% confidence interval (CI) was used to analyze the outcomes. Results Six studies involving 360 patients were included. Intrathecal dexmedetomidine was associated with a significantly longer sensory block duration (MD = −73.62; 95% CI = −101.09 to −46.15), faster onsets of sensory blockade and motor blockade, and a longer motor block duration than intrathecal magnesium sulfate. There was no significant difference between the regarding the rates of hypotension, bradycardia, shivering, and postoperative nausea and vomiting between the groups. Conclusions Dexmedetomidine is superior to magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia because of its more rapid onset and longer duration of spinal block without significant adverse effects.

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The Effects of 2 μG and 4 μG Doses of Dexmedetomidine in Combination with Intrathecal Hyperbaric Bupivacaine on Spinal Anesthesia and its Postoperative Analgesic Characteristics

Pain Research and Management ◽

10.1155/2014/956825 ◽

2014 ◽

Vol 19 (2) ◽

pp. 75-81 ◽

Cited By ~ 8

Author(s):

Abdulkadir Yektaş ◽

Enver Belli

Keyword(s):

Side Effects ◽

Spinal Anesthesia ◽

Intrathecal Injection ◽

Military Hospital ◽

Hyperbaric Bupivacaine ◽

Analgesic Effects ◽

Group 3 ◽

First Pain ◽

Different Doses ◽

Group 1

OBJECTIVE: To compare the postoperative analgesic characteristics and side effects of two different doses of intrathecal dexmedetomidine in combination with hyperbaric bupivacaine, and to evaluate the effects of these combinations on spinal anesthesia.METHODS: After obtaining approval from the local ethics committee, 60 male patients who were undergoing inguinal surgery and were classified as American Society of Anesthesiologists physical status class I were included in the study. The present study was conducted in 2003 in a military hospital with a capacity of 100 beds. The patients were randomly assigned to three groups of 20 patients: group 1, 0.5 mL saline added to 3 mL (15 mg) hyperbaric bupivacaine; and groups 2 and 3, 2 μg dexme-detomidine and 4 μg dexmedetomidine added to 3 mL (15 mg) hyperbaric bupivacaine, respectively. Medications were administered by intrathecal injection in a total volume of 3.5 mL. The postoperative analgesic characteristics, effects on spinal anesthesia and side effects were recorded.RESULTS: Demographic characteristics were similar among the groups. The mean (± SD) time to onset of pain was 220.75±112.7 min in group 1, 371.5±223.5 min in group 2 and 1042.50±366.78 min in group 3. Time to first pain sensation in group 3 was significantly longer than that in groups 1 and 2 (P<0.001).CONCLUSION: Two different doses of dexmedetomidine, an α2-adrenoceptor agonist with analgesic effects, resulted in an increased duration of analgesia and efficacy, decreased postoperative analgesic use and was associated with no notable adverse effects.

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