Premium
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
Author(s) -
Arcioni R.,
Palmisani S.,
Tigano S.,
Santorsola C.,
Sauli V.,
Romanò S.,
Mercieri M.,
Masciangelo R.,
De Blasi R. A.,
Pinto G.
Publication year - 2007
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2007.01263.x
Subject(s) - medicine , anesthesia , analgesic , levobupivacaine , sufentanil , placebo , randomized controlled trial , orthopedic surgery , surgery , alternative medicine , pathology
Background: New ways of decreasing post‐operative analgesic drug requirements are of special interest after major surgery. Magnesium sulfate (MgSO 4 ) alters pain processing and reduces the induction and maintenance of central sensitization by blocking the N ‐methyl‐ d ‐aspartate (NMDA) receptor in the spinal cord. We investigated whether supplementation of spinal anesthesia with combined intrathecally and epidurally infused MgSO 4 reduced patients’ post‐operative analgesia requirements. Methods: In a randomized, prospective, double‐blind, placebo‐controlled trial, we enrolled 120 consecutive patients undergoing orthopedic surgery during spinal anesthesia (levobupivacaine and sufentanil). Patients were randomly assigned to receive intrathecal MgSO 4 (94.5 mg, 6.3%), epidural MgSO 4 (2%, 100 mg/h), intrathecal and epidural MgSO 4 combined or spinal anesthesia alone (controls). Post‐operative morphine consumption was assessed in all groups by patient‐controlled analgesia (PCA). Results: Of the 120 patients enrolled, 103 (86%) completed the study. Morphine consumption at 36 h after surgery was 38% lower in patients receiving spinal anesthesia plus epidural MgSO 4 [– 14.963 mg; 95% confidence interval (CI), – 1.44 to – 28.49 mg], 49% lower in those receiving spinal anesthesia plus intrathecal MgSO 4 (– 18.963 mg; 95% CI, – 5.27 to – 32.65 mg) and 69% lower in the intrathecal–epidural combined group (– 26.963 mg; 95% CI, – 13.73 to – 40.19 mg) relative to control patients receiving spinal anesthesia alone. No complications developed during the post‐operative course or at 1 month after surgery. Conclusion: In patients undergoing orthopedic surgery, supplementation of spinal anesthesia with combined intrathecal and epidural MgSO 4 significantly reduces patients’ post‐operative analgesic requirements.