Department of Anesthesia, Faculty of Medicine, Tanta University, Tanta, Egypt.
Int J Obstet Anesth. 2010 Oct;19(4):401-4. doi: 10.1016/j.ijoa.2010.07.019. Epub 2010 Sep 15.
Combined spinal-epidural anaesthesia is commonly used for elective caesarean section. Intrathecal injection produces rapid onset with minimal doses of local anaesthetic and epidural administration can be used to prolong the block. Our study examined the effects of adding magnesium sulphate to epidural bupivacaine and fentanyl in patients undergoing elective caesarean section using combined spinal-epidural anaesthesia.
Women ASA physical status I or II at term were recruited. All received 2 mL intrathecal 0.5% hyperbaric bupivacaine, 10 mL epidural 0.25% plain bupivacaine with fentanyl 100 μg, and were randomly allocated to receive either 10 mL of epidural 0.9% sodium chloride or 10 mL epidural 5% magnesium sulphate. The quality of surgical anaesthesia, incidence of hypotension, Apgar scores, intraoperative pain assessment, onset of postoperative pain, sedation scores and side effects were recorded in the postoperative period.
Ninety women were recruited. There was no difference in the time taken for the block to reach T4 sensory level, time to reach the highest level of sensory block, time interval between first neuraxial injection and onset of surgery between the groups. Women who received magnesium had greater motor block and muscle relaxation (P<0.05). Apgar scores were 7 or more in almost all neonates in both groups. There was no significant difference in the incidence of hypotension, nausea and vomiting and duration of motor blockade between the groups. Women who received magnesium showed less shivering and later onset of post operative pain (P<0.05).
The addition of magnesium to epidural bupivacaine and fentanyl in women undergoing elective caesarean section with combined spinal-epidural anaesthesia improved intraoperative conditions and the quality of postoperative analgesia.
椎管内麻醉联合应用于择期剖宫产术。鞘内注射可产生快速起效，所需局部麻醉药剂量最小，硬膜外给药可延长阻滞时间。我们的研究旨在观察在椎管内麻醉联合应用布比卡因和芬太尼行择期剖宫产术中，硬膜外给予硫酸镁对患者的影响。
选择 ASA 分级Ⅰ或Ⅱ级足月产妇，鞘内给予 2 mL 0.5%重比重布比卡因，硬膜外给予 10 mL 0.25%布比卡因加芬太尼 100 μg，随机分为硬膜外给予 10 mL 生理盐水或 10 mL 5%硫酸镁。记录术中麻醉效果、低血压发生率、新生儿 Apgar 评分、术中疼痛评分、术后疼痛开始时间、镇静评分及不良反应。
共纳入 90 例患者，各组间阻滞达 T4 感觉平面时间、最高感觉阻滞平面时间、首次行神经轴索阻滞至手术开始时间差异无统计学意义。应用硫酸镁组运动阻滞和肌肉松弛程度较明显（P<0.05）。两组新生儿 Apgar 评分均在 7 分以上。低血压、恶心呕吐及运动阻滞持续时间差异无统计学意义。应用硫酸镁组寒战发生率较低，术后疼痛开始时间较晚（P<0.05）。
在椎管内麻醉联合应用布比卡因和芬太尼行择期剖宫产术中，硬膜外给予硫酸镁可改善术中情况和术后镇痛质量。
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