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Clinical Comparative Study Comparing Efficacy of Intrathecal Fentanyl and Magnesium as an Adjuvant to Hyperbaric Bupivacaine in Mild Pre-Eclamptic Patients Undergoing Caesarean Section
Abstract:Adequate analgesia following caesarean section decreases morbidity, hastens ambulation, improves patient outcome and facilitates care of the newborn. Intrathecal magnesium, an NMDA antagonist, has been shown to prolong analgesia without significant side effects in healthy parturients. The aim of this study was to evaluate the onset and duration of sensory and motor block, hemodynamic effect, postoperative analgesia, and adverse effects of magnesium or fentanyl given intrathecally with hyperbaric 0.5% bupivacaine in patients with mild preeclampsia undergoing caesarean section. Sixty women with mild preeclampsia undergoing elective caesarean section were included in a prospective, double blind, controlled trial. Patients were randomly assigned to receive spinal anesthesia with 2 mL 0.5% hyperbaric bupivacaine with 12.5 μg fentanyl (group F) or 0.1 ml of 50% magnesium sulphate (50 mg) (group M) with 0.15ml preservative free distilled water. Onset, duration and recovery of sensory and motor block, time to maximum sensory block, duration of spinal anaesthesia and postoperative analgesic requirements were studied. Statistical comparison was carried out using the Chi-square or Fisher’s exact tests and Independent Student’s t-test where appropriate. The onset of both sensory and motor block was slower in the magnesium group. The duration of spinal anaesthesia (246 vs. 284) and motor block (186.3 vs. 210) were significantly longer in the magnesium group. Total analgesic top up requirement was less in group M. Hemodynamic parameters were similar in both the groups. Intrathecal magnesium caused minimal side effects. Since Fentanyl and other opioid congeners are not available throughout the country easily, magnesium with its easy availability and less side effect profile can be a cost effective alternative to fentanyl in managing pregnancy induced hypertension (PIH) patients given along with Bupivacaine intrathecally in caesarean section.
Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1108727Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 1716
 Wallace DH, Leveno KJ, Cunningham FG, et al. Randomized comparison of general and regional anesthesia for cesarean delivery in pregnancies complicated by severe pre-eclampsia. Obstet Gynecol 1995; 86:193–9.
 Karinen J, Rasanen J, Alahuhta S,et al. Maternal and uteroplacental haemodynamic state in pre-eclamptic patients during spinal anaesthesia for caesarean section. Br J Anaesth 1996; 76:616–20.
 Hood, David D. MD; Curry, Regina RN. Spinal versus epidural anesthesia for cesarean section in severely pre-eclamptic patients: A retrospective study. Anesthesiology 1999; 90:1276–12s82.
 Roseag OP, LuiACP, Cicutti NJ, et al. Perioperative multimodal pain therapy for caesarean section: analgesia and fitness for discharge. Can J Anesth 1997; 44:803–9.
 Schobel HP, Fischer T, Heuszer K, et al. Preeclampsia: a state of sympathetic overactivity. N Engl J Med 1996; 335:1480–5.
 Kroin JS, McCarthy RJ, Von Roenn N, et al. Magnesium sulphate potentiates morphine antinociception at the spinal level. Anesth Analg 2000; 90:913–7.
 Buvanendran A, McCarthy RJ, Kroin JS, et al. Intrathecal magnesium prolongs fentanyl analgesia: a prospective, randomized, controlled trial. Anesth Analg 2002; 95:661–6.
 Shoebi G, Sadegi M, Firazian A, Tabassomi F. The additional effect of magnesium to lidocaine in spinal anaesthesia for caesarean section. Int J Pharmacol 2007; 3:425-7.
 Ozalevli M, Cetin TO, Unlugence H, et al. The effect of adding intrathecal magnesium sulphate to bupivacaine fentanyl spinal anaesthesia. Acta Anaesthesiol Scand 2005; 49:1514–9.
 Mageed Nabil A, El-Ghoniemy Yasser F. Intrathecal fentanylmagnesium for fast-track cardiac anaesthesia. Eg J Anaesth 2005; 21:289–93.
 Arcioni R, Palmisoni S, Tigano S et al. Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post-operative analgesic requirements: a prospective, randomized, double-blind, controlled trial in patients undergoing major orthopedic surgery. Acta Anaesthesiol Scand 2007; 51:482–9.
 Marzouk S, El-Hady NA, Lotfy M, Darwish HM. The effect of three different doses of intrathecal magnesium sulphate on spinal opioid analgesia. Eg J Anaesth 2003; 19:405-9.
 Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. Jul 2000; 1831:S1-22.
 American College of Obstetricians and Gynecologists: Hypertension in pregnancy. ACOG Technical Bulletin No. 219. Washington DC: 199
 Liu HT, Hollman MW, Liu WH et al. Modulation of NMDA receptor function by ketamine and magnesium. Part 2. Anesth Analg 2001; 92:1173–81.
 Woolf CJ, Chong MS. Preemptive analgesia-treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993; 77(2):362-79.
 Woolf CJ, Thompson SW. The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain 1991; 44:293–9.
 Ko SH, Lim HR, Kim DC, et al. Magnesium sulfate does not reduce postoperative analgesic requirements. Anesthesiology 2001; 95:640–6.
 S. Malleeswaran, N. Panda, P. Mathew, R. Bagga. A randomized study of magnesium sulphateas an adjuvant to intrathecal bupivacaine in patients with mild pre-eclampsia undergoing caesarean section. International Journal of Obstetric Anesthesia (2010) 19, 161-166.
 Jeffrey MichaelSmith, Richard F Lowe, Judith Fullerton, et al. An Integrative Review of the Side Effects Related to the Use of Magnesium Sulfate for Pre-eclampsia and Eclampsia Management. BMC Pregnancy Childbirth. 2013;13(34)
 Witlin AG, Sibai BM. Magnesium sulfate therapy in preeclampsia and eclampsia. ObstetGynecol1998; 92:883-9.
 Simpson JI, Eide TR, Schiff GA et al. Intrathecal magnesium sulphate protects the spinal cord from ischaemic injury during thoracic aorta cross clamping. Anesthesiology 1994; 81: 1493–9.
 Takano Y, Sato E, Kaneko T, Sato I. Antihyperalgesic effects of intrathecally administered magnesium sulphate in rats. Pain 2000; 84:175–9.