Mokaram Dori Mehrdad, Foruzin Farid
Department of Anesthesiology and Pain Center, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Anesth Pain Med. 2016 Sep 18;6(6):e9651. doi: 10.5812/aapm.9651. eCollection 2016 Dec.
An appropriate anesthesia duration with minimal side effects and prolonged postoperative analgesia are the ideal characteristics of an intrathecal drug used during spinal anesthesia. Neostigmine and magnesium sulphate have been used as spinal anesthetic additives with narcotics and local anesthetics.
This study aimed to assess the analgesic properties of intrathecal neostigmine and magnesium sulphate by adding them to intrathecal bupivacaine-fentanyl.
: In total, 210 patients undergoing tibial fracture surgery were enrolled in a double-blinded clinical trial study. Patients were randomly allocated to one of three groups: group F received 10 mg of bupivacaine and 25 µg of fentanyl as intrathecal drug for spinal anesthesia, group N received 150 µg of neostigmine added to 10 mg of bupivacaine and 25 µg of fentanyl, and group M received 50 mg of magnesium sulphate added to 10 mg of bupivacaine and 25 µg of fentanyl. Analgesia duration, motor blockade scores, postoperative pain scores 6 and 12 hours after surgery, postoperative voiding time, and the incidence of hypotension, bradycardia, respiratory depression, and nausea and vomiting were recorded.
Group M showed significantly longer analgesia duration (330.76 ± 80.98 minutes) than group F (280.98 ± 60.33 minutes). The pain scores in group M 6 hours (NRS: 2.44 ± 0.98) and 12 hours (NRS: 4.10 ± 0.88) after surgery were significantly lower than those of the other two groups. Before discharge from recovery, motor blockade scores and voiding time were not significantly different between the three groups. Hypotension (40%), bradycardia (25%), and nausea and vomiting (70%) were more obvious among group N patients. Respiratory depression did not occur in any patients.
The addition of 50 mg of magnesium sulfate to a bupivacaine-fentanyl solution for intrathecal anesthesia improved the efficacy and duration of the analgesia without any significant side effects. The addition of 150 µg of neostigmine increased the incidence of hypotension, bradycardia, and nausea and vomiting. Moreover, neostigmine failed to prolong analgesia duration.
理想的鞘内用药应具备合适的麻醉时长、最小的副作用以及延长的术后镇痛效果，这些是脊髓麻醉期间使用的鞘内药物的理想特性。新斯的明和硫酸镁已被用作与麻醉药和局部麻醉药联合使用的脊髓麻醉添加剂。
本研究旨在通过将鞘内新斯的明和硫酸镁添加到鞘内布比卡因-芬太尼中，评估它们的镇痛特性。
总共210例接受胫骨骨折手术的患者被纳入一项双盲临床试验研究。患者被随机分配到三组中的一组：F组接受10mg布比卡因和25μg芬太尼作为鞘内脊髓麻醉药物；N组接受添加到10mg布比卡因和25μg芬太尼中的150μg新斯的明；M组接受添加到10mg布比卡因和25μg芬太尼中的50mg硫酸镁。记录镇痛时长、运动阻滞评分、术后6小时和12小时的疼痛评分、术后排尿时间以及低血压、心动过缓、呼吸抑制、恶心和呕吐的发生率。
M组的镇痛时长（330.76±80.98分钟）明显长于F组（280.98±60.33分钟）。M组术后6小时（数字评分量表[NRS]：2.44±0.98）和12小时（NRS：4.10±0.88）的疼痛评分明显低于其他两组。在恢复室出院前，三组之间的运动阻滞评分和排尿时间无显著差异。N组患者的低血压（40%）、心动过缓（25%）以及恶心和呕吐（70%）更为明显。所有患者均未发生呼吸抑制。
在布比卡因-芬太尼溶液中添加50mg硫酸镁用于鞘内麻醉可提高镇痛效果和时长，且无任何明显副作用。添加150μg新斯的明会增加低血压、心动过缓以及恶心和呕吐的发生率。此外，新斯的明未能延长镇痛时长。
