Yadav Monu, Kumar P Bhanu, Singh Madhavi, Gopinath Ramachandran
Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
Department of Anaesthesia, Cornwall Regional Hospital, Montego Bay, Jamaica.
Anesth Essays Res. 2015 Sep-Dec;9(3):364-8. doi: 10.4103/0259-1162.159764.
The spinal anesthesia has the definitive advantage that profound nerve block can be produced in a large part of the body by the relatively simple injection of a small amount of local anesthetic.
The use of adjuvant drugs with local anesthetics for spinal is intended to improve the success of regional anesthesia. The present study evaluated magnesium sulfate in two different doses and fentanyl as an adjuvant to bupivacaine for spinal anesthesia.
Following Institutional Ethical Committee approval and written informed consent, a prospective randomized double-blinded study was conducted in 81 cases. Patients included were of either gender belonging to American Society of Anesthesiology (ASA) I or ASA II status undergoing elective infraumbilical surgeries of <3 h. Patients were randomized into four groups and were administered an intrathecal solution of (1) Group NS: 3 cc of 0.5% bupivacaine + 0.5 cc of NS. (2) Group F: 3 cc of 0.5% bupivacaine + 25 mcg fentanyl (0.5 cc). (3) Group M 50: 3 cc of 0.5% bupivacaine + 50 mg magnesium sulfate diluted to 0.5 cc with NS. (4) Group M 100: 3 cc of 0.5% bupivacaine + 100 mg magnesium sulfate diluted to 0.5 cc with NS. The variables assessed were visual analog pain scale, pruritus, intensity of motor block and somnolence before and after intrathecal injection at 5, 10, 15, 30, 45, and 60 min in the 1(st) h, at every 30 min in next hour and then hourly thereafter.
The mean duration of analgesia in normal saline group, fentanyl group, M 50 and M 100 groups are 272.8 (standard error [S.E.] of mean 22.9), 360.0 (S.E. of mean 28.8), 252.5 (S.E. of mean 15.0), 276.6 (S.E. of mean 29.5) min, respectively.
The addition of magnesium sulfate in the two different doses (50, 100 mg) does not affect the quality of block or duration of analgesia. However, M 100 is as effective as fentanyl as far as the duration of analgesia is concerned.
脊髓麻醉具有显著优势，即通过相对简单地注射少量局部麻醉剂就能在身体大部分部位产生深度神经阻滞。
将辅助药物与局部麻醉剂用于脊髓麻醉旨在提高区域麻醉的成功率。本研究评估了两种不同剂量的硫酸镁以及芬太尼作为布比卡因脊髓麻醉辅助剂的效果。
经机构伦理委员会批准并获得书面知情同意后，对81例患者进行了一项前瞻性随机双盲研究。纳入的患者为美国麻醉医师协会（ASA）I或ASA II级的择期脐下手术患者，手术时间小于3小时，性别不限。患者被随机分为四组，分别给予鞘内注射溶液：（1）生理盐水组（NS组）：3毫升0.5%布比卡因 + 0.5毫升生理盐水。（2）芬太尼组（F组）：3毫升0.5%布比卡因 + 25微克芬太尼（0.5毫升）。（3）M 50组：3毫升0.5%布比卡因 + 50毫克硫酸镁用生理盐水稀释至0.5毫升。（4）M 100组：3毫升0.5%布比卡因 + 100毫克硫酸镁用生理盐水稀释至0.5毫升。评估的变量包括视觉模拟疼痛量表、瘙痒、运动阻滞强度和嗜睡程度，在鞘内注射后第1小时的5、10、15、30、45和60分钟，接下来1小时每30分钟以及之后每小时进行评估。
生理盐水组、芬太尼组、M 50组和M 100组的平均镇痛持续时间分别为272.8（平均标准误[S.E.]为22.9）、360.0（平均标准误为28.8）、252.5（平均标准误为15.0）、276.6（平均标准误为29.5）分钟。
添加两种不同剂量（50、100毫克）的硫酸镁不影响阻滞质量或镇痛持续时间。然而，就镇痛持续时间而言，M 100与芬太尼效果相当。
