Combination of magnesium sulphate and ropivacaine epidural analgesia for hip arthroplasty in dogs

The aim of this study was to determine whether lumbosacral epidural administration of magnesium sulphate added to ropivacaine prolongs and improves perioperative analgesia, without adverse effects on motor block duration or hind limb neurological function, in dogs undergoing hip arthroplast

Magnesium sulphate attenuate remifentanil-induced postoperative hyperalgesia via regulating tyrosine phosphorylation of the NR2B subunit of the NMDA receptor in the spinal cord

Data of PWTL and PWMT values in the study. (XLS 19 kb

بررسی تاثير اضافه کردن سولفات منيزيوم به ليدوکائين اينتراتکال بر مدت بی دردی پس از اعمال ارتوپدی اندام تحتانی

زمينه و هدف: اعمال جراحی ارتوپدی به دليل ماهيت جراحی روی استخوان و مفاصل با درد پس از عمل بالايی همراهند. استفاده از مخدر­های وريدی، عضلانی، داخل نخاعی و اپيدورال همگي از روش­های کنترل درد پس از عمل هستند که دارای عوارض جانبی متعددی مي­باشند. تجويز منيزيوم داخل نخاعی با بلوک گيرنده آن "متيل­دي­آسپارتات" باعث کاهش درد پس از عمل مي­شود، بدون آنکه با افزايش عوارض جانبی همراه باشد. هدف از انجام اين مطالعه تعيين تاثير اضافه کردن سولفات منيزيوم به ليدوکائين-­اپي­نفرين داخل نخاعی در مدت بي­دردی پس از عمل، در جراحي­های ارتوپدی اندام تحتانی است. مواد و روش­ها: اين مطالعه به­صورت کارآزمايی بالينی دوسوکور در بيماران کانديد عمل ارتوپدي اندام تحتانی انجام شده­است. برای اين منظور 156 بيمار به دو گروه تقسيم شدند، که يک گروه سولفات منيزيوم همراه با ليدوکائين-اپي­نفرين و گروه ديگر ليدوکائين-اپي­نفرين همراه با آب مقطر به­عنوان پلاسبو دريافت نمود. مدت زمان بی دردی بر­اساس فاصله زماني درخواست مسکن توسط بيمار از زمان تزريق دارو، درد بيماران بر­اساس مقياس ديداری درد و ميزان پتيدين مصرفی در دو گروه محاسبه شد. اطلاعات توسط نرم­افزار آماری SPSS 12 آناليز گرديد. يافته ­ها: در مطالعه ما ميانگين سنی بيماران در دو گروه درمانی و کنترل به ترتيب 5/7±34 و 1/8±9/31 سال بود. ميانگين مدت زمان بی دردی در گروه درمانی ، 7/29±7/143 دقيقه و در گروه کنترل، 1/18± 9/100 دقيقه بود که مدت زمان بي­دردی به­طور معني­داری در گروه سولفات منيزيوم طولاني­تر از گروه کنترل بوده­است. ميزان درد بيماران بر­اساس مقياس ديداری درد در گروه سولفات منيزيوم 36/0±9/3 و در گروه کنترل 35/0 ± 65/5 بود، که به­طور معني­داری در گروه سولفات منيزيوم، کمتر از گروه کنترل بوده است (000/0=P). ميانگين پتيدين مصرفی در گروه سولفات منيزيوم 24/6 ±15 ميلي­گرم و در گروه کنترل 27/6 ±33 ميلي­گرم بود که از نظر آماری معني­دار بود (000/0=P. نتيجه گيری: سولفات منيزيوم همراه با ليدوکائين موجب کاهش درد پس از عمل بيشتری در مقايسه با ليدوکائين تنها مي­شود

A comparative study of different adjuncts to enhance the effects of intrathecal bupivacaine

Background: Spinal anaesthesia is the commonly used technique for lower abdominal surgeries. Adjuvants to bupivacaine have been used to provide good quality of perioperative and postoperative analgesia. The aim of the study was to evaluate the effects of subarachnoid administration of bupivacaine with clonidine, magnesium, dexmedetomidine and saline group.Methods: The prospective, comparative single blind study included 120 patients in American society of anaesthesiologist (ASA) grade I and II, scheduled for lower abdominal surgeries were allocated in four groups. Each group included 15 mg bupivacaine with various adjuvants (30 µg clonidine, 50 mg magnesium sulphate and 3µg dexmedetomidine) were compared with saline group (group S).Results: Time of onset was earlier in groups D and C but delayed in group M. The total power regains (B0) in group D (250.8±18.87), group M (235.23±24.66) and group C (242.70±25.98) were significantly delayed (p<0.05) as compare with group S (180.07±18.53). Demand of analgesia was significantly earlier in group S as compared with groups C, M and D. Similarly, the time of two segment regression was significantly earlier in group S as compared with groups C, M and D (p<0.001). Patients were hemodynamically stable in groups D, C and M as compared to Group S.Conclusions: Dexmedetomidine and clonidine were equally effective and better as compared to magnesium as an adjunct to intrathecal bupivacaine

A comparative study of intrathecal nonopioid adjuvants to hyperbaric bupivacaine for spinal anaesthesia

Background: Intrathecal drugs when used as adjuvant to spinal anaesthesia produce substantial anti-nociception and potentiate analgesia of bupivacaine. This study was planned to evaluate the effects of intrathecal non opioid drugs-clonidine, midazolam, neostigmine and magnesium sulphate on duration of analgesia, characteristics of SA and hemodynamic stability when added to 0.5% hyperbaric bupivacaine for spinal anaesthesia.Methods: In this randomized, prospective, double blind study, 100 ASA physical status I and II adults patients posted for elective lower abdominal surgery were divided into 4 groups (n=25). Group BN received preservative free neostigmine 25µg, group BMG received Mgso4 50mg, group BC received clonidine 30µg and BM received midazolam 2mg with 15mg hyperbaric bupivacaine. Duration of postoperative analgesia, effect on onset and duration of sensory and motor block, incidence of side effects was noted. Continuous variables were compared using one way Analysis of Variance (ANOVA).Results: The duration of postoperative analgesia was significantly prolonged in BM group 391.64 (132.98) minutes, followed by BN group 308.76 (127.40), BC group 296.60 (52.77) and BMG group 252.2 (86.76). The numbers of analgesic doses in 24 hours were significantly less in BM group. One patient required additional analgesia in BM group as against 40%, 36% and 64% in BN, BC, BMG group respectively. The duration of sensory block was significantly prolonged in group BM followed by group BC and BN.Conclusions: Intrathecal midazolam provides superior analgesia without clinically relevant side effects. The onset of analgesia was rapid and duration prolonged with intrathecal midazolam followed by neostigmine and clonidine

An evaluation of hyperbaric ropivacaine with magnesium as an adjuvant in lower abdominal surgeries among the north Indian subjects: a double-blind randomized trial

Background: An evaluation of intrathecal hyperbaric ropivacaine without adjuvant and with adjuvant magnesium for lower abdominal surgeries.Methods: This was a prospective, randomized, double-blind study conducted among the patients aged 18 to 60 years planned for lower abdomen surgeries under spinal anaesthesia and ASA grade I or II. Patients were randomly allocated to two groups (30 in each): ropivacaine Group (R group): spinal anesthesia with 3ml of 0.6% hyperbaric ropivacaine (18mg )+ 0.5ml NS. hyperbaric ropivacaine + Magnesium Group (R+M group ):   spinal anesthesia with 3ml of 0.6% hyperbaric ropivacaine (18mg) + 0.5ml magnesium sulphate (50 mg).  All the patients scheduled for operation were given oral tablets ranitidine 150 mg and Alprazolam 0.25mg in the night before surgery.Results: There was no significant difference in the basic characteristics between the groups. The mean HR, MAP and SpO2 in both the groups decreased over the periods as compared to baseline. However, the trend of HR over the periods remains similar in both R and R+M groups. The bromage levels were significantly (p=0.0001) higher among the patients of Group R compared with R+M.  The 2 segment sensory regression (min), Sensory regression S2 (hr), motor recovery (hrs) and long term mobilization after spinal anesthesia were significantly (p=0.0001) lower among the patients of Group R compared with R+M. The complications were lower in Group R+M than R.Conclusions: Magnesium may be more suitable drug in surgeries in which muscle relaxation has greater value in lower abdominal surgeries

Sulfato de magnésio prolonga a analgesia epidural lombosacral induzida pela quetamina em carneiros

OBJETIVO: Determinar os efeitos analgésicos, motores, sedativos e sistêmicos da adição de sulfato de magnésio na analgesia epidural com quetamina em carneiros. MÉTODOS: Foram utilizados seis carneiros machos sadios, pesando 43 ± 5 kg, com idade entre 20 a 36 meses. Cada animal recebeu três tratamentos, com duas semanas entre experimentos via administração epidural: (1) quetamina (KE; 2,5 mg/kg), (2) sulfato de magnésio (MG; 100 mg) e (3) KE + MG (KEMG; 2,5 mg/kg + 100 mg, respectivamente). As administrações epidurais foram administradas no espaço lombosacral. Analgesia, bloqueio motor, sedação, efeitos cardiovasculares, freqüência respiratória, temperatura retal e de pele foram avaliados antes (basal) e depois da administração dos fármacos até o fim da analgesia. RESULTADOS: A duração da analgesia com o tratamento KEMG foi 115 ± 17 min (média ± DP), duas vezes superior ao obtido com o tratamento KE (41 ± 7 min) ou tratamento MG (29 ± 5 min) isolados. Os tratamentos KE e KEMG induziram bloqueio motor severo. As pressões arteriais e freqüência cardíaca não foram estatisticamente significantes nestes animais. CONCLUSÃO: A adição de sulfato de magnésio a analgesia epidural com quetamina é viável, e pode ser usado para prolongar os efeitos analgésicos destes bloqueios em carneiros.ABSTRACT - PURPOSE: To determine the analgesic, motor, sedation and systemic effects of lumbosacral epidural magnesium sulphate added to ketamine in the sheep. METHODS: Six healthy adult male mixed-breed sheep; weighing 43 ± 5 kg and aged 20–36 months. Each sheep underwent three treatments, at least 2 weeks apart, via epidural injection: (1) ketamine (KE; 2.5 mg/kg), (2) magnesium sulphate (MG; 100 mg), and (3) KE + MG (KEMG; 2.5 mg/kg + 100 mg, respectively). Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, cardiovascular effects, respiratory rate, skin temperature, and rectal temperature were evaluated before (baseline) and after drug administration as needed. RESULTS: The duration of analgesia with the lumbosacral epidural KEMG combination was 115 ± 17 min (mean ± SD), that is, more than twice that obtained with KE (41 ± 7 min) or MG (29 ± 5 min) alone. KE and KEMG used in this experiment induced severe ataxia. The heart rate and arterial blood pressures changes were no statistical difference in these clinically health sheep. CONCLUSION: The dose of magnesium sulphate to lumbosacral epidural ketamine in sheep is feasible, and can be used in procedures analgesics in sheep

Update on adjuvants in regional anaesthesia

This is a review article on adjuvants to neuroaxial anaesthesia and peripheral nerve blocks used in clinical practice: opioids, asoconstrictors, clonidine, NMDA antagonists, midazolam, glucocorticoids, nonsteroidal anti-inflammatory drugs and neostigmine. Mechanisam and site of action of each of them is described. It is followed by discussion of experimental and clinical data published in the last five years