Comparative clinical evaluation of intrathecal bupivacaine heavy, bupivacaine with magnesium sulphate and bupivacaine with neostigmine for infraumbilical surgeries – A clinical study

Abstract

Aim: This study aims to assess the anaesthetic effects of adjuvant therapies with neostigmine or magnesium sulphate compared with bupivacaine intrathecally, alone in patients undergoing infraumbilical surgeries under subarachnoid block. Materials and Methods: After approval from the Institutional Ethics Committee and informed written consent from patients, the present study was carried out in 90 patients of ASA Class I and II, aged between 18 and 50 years, of either sex (M and F), scheduled for elective infraumbilical surgeries. The selected patients were randomly divided into three equal groups of 30 patients. Group I patients received bupivacaine heavy (0.5%) 3 ml (15 mg) +0.5 ml normal saline. Group II patients received bupivacaine 3 ml (5 mg) with preservative-free magnesium sulphate 0.5 ml (50 mg). Group III patients received bupivacaine (3 ml) with neostigmine 0.5 ml (25 μg). The parameters assessed were the duration of sensory and motor blockade, quality of block, perioperative haemodynamic effects and duration of post-operative analgesia. Results: Addition of 50 mg of magnesium sulphate significantly increases the duration of sensory block in Group II (397.67 ± 14.003) as compared to Group III (188.67 ± 23.887) and Group I (183.10 ± 8.185), duration of motor block in Group II (213.67 ± 13.767) as compared to Group III (164.67 ± 23.154) and Group I (177.30 ± 7.312), duration of analgesia in Group II (349.00 ± 22.453) as compared to Group III (327.83 ± 31.61) and Group I (241.33 ± 16.399). Haemodynamic parameters were stable in both Groups I and II. Quality of block was much better in Group II (3.83 ± 0.40) as compared to Group III (3.49 ± 0.68) and Group I (2.83 ± 0.79). Conclusion: According to the results obtained from the present study, it is concluded that addition of 50 mg of magnesium sulphate as an adjuvant to intrathecal bupivacaine is better in view of the duration of sensory and motor blockade, quality of block and duration of analgesia (requirement of rescue analgesia) without any significant increase in adverse effects.