Magnesium sulfate intravenous infusion versus intrathecal injection for prevention of post-spinal shivering during lower limb fracture surgery: a randomized controlled study

Sherif Abdullah Mohamed,Nevan Mohamed El Mekawy,Ahmed Ibrahim Abdelkhalik Elsonbaty,Mohamed Ibrahim Abdelkhalik Elsonbaty,Raed Mohamed Abdelfattah

doi:10.1186/s42077-021-00147-5

Abstract

BackgroundShivering is a prevalent adverse event after spinal anesthesia, often disturbing to medical staff and hazardous to patients. Intravenous magnesium sulfate [MgSO4] has been proven to be effective in prevention of post-spinal shivering. However, the risk of intravenous route to develop hypermagnesemia in certain patients encouraged us to do this study in order to investigate the effectiveness of intrathecal MgSO4 as an alternative to the intravenous route in prevention of post-spinal shivering. The enrolled 135 patients were allocated to 3 groups, 45 patients each, groups: intrathecal [T], IV MgSO4 infusion [M], and control [C]. Group T (no. = 45) received 50 mg MgSO4 added to heavy bupivacaine 0.5% intrathecally, while group M (no. = 45) received IV MgSO4 as 50 mg/kg in 100 cc saline within 20 min as a loading dose then infused as 2 mg/kg/h after performing spinal anesthesia. The vital signs, duration and shivering grades, temperature, and adverse effects were recorded.ResultsT and M groups showed a significant difference from control as regard the incidence of shivering with 40%, 26.7%, and 64.4% for T, M, and C groups, respectively, patients needed rescue pethidine were 17.7%, 11.1%, and 60% for group T, M, and C, respectively, and shivering duration (min) was 24.86 ± 7.411, 20.47 ± 6.61, and 45 ± 36.2 for groups T, M, and C, respectively with a statistically insignificant difference between group T and M as regards these parameters.ConclusionsIntrathecal MgSO4 has the potentiality to be used as an alternative to IV route regarding prevention of post-spinal shivering. This makes advantage for intrathecal magnesium use in patients at risk for magnesium toxicity.

Highlights

Shivering is a prevalent adverse event after spinal anesthesia, often disturbing to medical staff and hazardous to patients
Intravenous magnesium can decrease shivering incidence in patients receiving neuraxial anesthesia by different mechanisms (Kizilirmak et al 1997) but may have some lethal effects related to hypermagnesemia (Connolly and Worthley 1999)
After obtaining the institutional ethics committee approval, 135 patients between 20 and 45 years age, with grades I and II according to the American Society of Anesthesiologists [ASA] undergoing orthopedic trauma operation for lower limb under spinal anesthesia were involved in the study

Summary

Introduction

Shivering is a prevalent adverse event after spinal anesthesia, often disturbing to medical staff and hazardous to patients. Intravenous magnesium sulfate [MgSO4] has been proven to be effective in prevention of post-spinal shivering. The risk of intravenous route to develop hypermagnesemia in certain patients encouraged us to do this study in order to investigate the effectiveness of intrathecal MgSO4 as an alternative to the intravenous route in prevention of post-spinal shivering. Shivering is a frequent adverse event of neuraxial block. Intravenous magnesium can decrease shivering incidence in patients receiving neuraxial anesthesia by different mechanisms (Kizilirmak et al 1997) but may have some lethal effects related to hypermagnesemia (Connolly and Worthley 1999). Some intrathecal adjuvants were effective in prevention of shivering (Eskandr and Ebeid 2016) This encouraged studies for the use of intrathecal MgSO4 administration that proved to be effective in prevention and controlling the perioperative

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Conclusion