Intravenous Magnesium Sulfate Infusion Research Articles

Tracheal intubation without using neuromuscular blocking drugs in elective surgery. A Comparative Study

Background: Usually, neuromuscular blocking drugs are used for facilitating tracheal intubation but sometimes limitations exist as in procedures where neuromuscular monitoring is required or that of short duration. So, using an alternative method is important for providing good intubating conditions. Patients and methods: Eighty-eight patients in Zagazig University hospitals were randomly divided into two equal groups, group-M (Magnesium group) and group-P (high dose of propofol group). Group (M) received Magnesium sulfate (40 mg/kg), Fentanyl (2 μg/kg) and Propofol (2 mg/kg). Group (P) received Fentanyl (2 μg/kg) and Propofol (3 mg/kg). Assessment of quality of intubation conditions and hemodynamic response to tracheal intubation were done. Results: Group (M) had better intubation score and also less hemodynamic response to endotracheal intubation than group (P). Conclusion: Intravenous infusion of magnesium sulfate (40 mg/kg) before induction leading to better intubation score and also less haemodynamic response to endotracheal intubation than high dose of propofol.

The Effect of Intravenous Magnesium Sulphate as an Adjuvant in the Treatment of Acute Exacerbations of COPD in the Emergency Department: A Double-Blind Randomized Clinical Trial.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are serious complications that often require immediate intervention in an emergency department (ED). The aim of this study was to investigate the effect of intravenous magnesium sulphate as an adjuvant in the treatment of AECOPD in the ED. In a double-blind, randomized clinical trial, a total of 60 patients with AECOPD presenting to the ED of Imam Khomeini Hospital in Sari, Iran, were included. The study was conducted between September 2016 and February 2018. Eligible patients were randomly allocated into two groups of intervention and control. Patients in the intervention and control groups received intravenous infusion of magnesium sulfate (2 gr) or normal saline over 30 minutes, respectively. For all patients, Borgdyspnea score, forced expiratory volume in one second (FEV1) result and clinical variables of interest were evaluated before the beginning of the intervention, and also 45 minutes and 6 hours after the commencement of intervention. Regardless of time of evaluation, pulse rate (PR), respiratory rate (RR) and Borg score in intervention group was lower than control group. Also, FEV1 and SPO2 were greater in intervention group compared to control group. However, these differences were not statistically significant (between-subject differences or group effect) (p<0.001). The trends of FEV1, SPO2, PR, RR and Borg score were similar between two groups of study (no interaction effect; P>0.05). According to the results of this study, it seems that using intravenous magnesium sulfate has no significant effect on SPO2, FEV1, RR, and PR of patients with AECOPD who presented to ED.

Analgesic and hemodynamic effects of intravenous infusion of magnesium sulphate versus dexmedetomidine in patients undergoing bilateral inguinal hernial surgeries under spinal anesthesia: a randomized controlled study

BackgroundSpinal anesthesia is commonly employed during inguinal hernial surgeries. Its short duration may, however, be considered a limitation, especially for bilateral hernial repair. The aim of this research is to investigate the analgesic and hemodynamic effects of intravenous infusion of both MgSO4 and dexmedetomidine on patients undergoing bilateral inguinal hernia surgeries under spinal anesthesia. MethodsThis study was a prospective, randomized, double-blinded controlled trail. It included 60 male patients who had been scheduled for bilateral elective inguinal hernia surgery under spinal anesthesia at Kasr Al-Aini hospital. Patients were randomly allocated to one of three groups (n = 20 each) to receive 50 mL of 0.9% saline intravenous infusion of either dexmedetomidine 0.5 μg.kg-1. h-1 (Group D) or magnesium sulphate 15 mg.kg-1. h-1 (Group M) or normal saline (Group S). The primary outcome of this study was set as the total duration of analgesia. Secondary outcomes were set as the onset and duration of sensory and motor blockade, perioperative hemodynamics, and the total 24-hour postoperative morphine consumption. ResultsDurations of sensory and motor blockades as well as durations of analgesia were all significantly longer among patients in Group D (mean 2.2, 3.5, 5.8 hours respectively) and Group M (mean 2.2, 3.3, 5.2 hours respectively), in comparison to Group S (mean 1.5, 2.7, 3.9 hours respectively). No significant differences were found in systolic or diastolic arterial blood pressure, heart rate oxygen saturation, cardiac output, or stroke volume among the study groups. Seven patients in Group D and four patients in Groups M and S developed hypotension. ConclusionIntravenous infusion of either dexmedetomidine or MgSO4 with spinal anesthesia effectively improves the quality of spinal anesthesia and prolongs the duration of postoperative analgesia and decreases the 24-hour postoperative morphine consumption. Results also demonstrated that the use of dexmedetomidine resulted in a slightly longer duration of analgesia, whilst the use of MgSO4 resulted in slightly better hemodynamic stability.

To study the efficacy of intravenous infusion of magnesium sulfate in the Indian population during epidural anesthesia using 0.5% bupivacaine for postoperative pain in infra-umbilical surgery

To study the efficacy of intravenous infusion of magnesium sulfate in the Indian population during epidural anesthesia using 0.5% bupivacaine for postoperative pain in infra-umbilical surgery

Controlled Hypotension During Endoscopic Sinus Surgery: A Comparison of Propofol and Magnesium Sulfate

Objective: Controlled hypotension is considered as an effective technique for reducing blood loss and optimizing the surgical field. This study was designed to compare intravenous infusion of propofol and magnesium sulfate for achieving controlled hypotension during elective endoscopic sinus surgery.

Could intraoperative magnesium sulphate protect against postoperative cognitive dysfunction?

Although there is much concern about the pathogenesis of postoperative cognitive dysfunction (POCD); no effective prevention strategies are currently described. The aim of this work was to study whether intraoperative magnesium sulphate could have a protective effect against developing POCD and to study its impact on serum level of S100B, a marker of neuronal degeneration. This is a prospective randomized controlled trial carried out on 80 participants undergoing elective laparoscopic cholecystectomy, 40 participants received conventional general anesthesia (conventional anesthesia group) and 40 participants received conventional general anesthesia with extra administration of intraoperative magnesium sulphate (Mg sulphate group). Cognitive assessment for both groups was done preoperatively and 1 week postoperatively using Paired Associate Learning test (PALT) and Benton Visual Retention Test (BVRT). Quantitative determination of serum S100B was done for both groups preoperatively and one week postoperatively by using an enzyme- linked immunoabsorbent assay technique. Postoperative PALT and BVRT were significantly lower than preoperative PALT and BVRT in the conventional anesthesia group (P value =0.043, P value =0.015 respectively), but not in the Mg sulphate group (P value =0.134, P value =0.151 respectively). Postoperative S100B was significantly higher than preoperative S100B in the conventional anesthesia group (P value =0.006), but not in the Mg sulphate group (P value =0.293). Administration of intravenous infusion of magnesium sulphate during conventional general anesthesia can protect against POCD and attenuate the post operative elevation of serum S100B.

A Comparative Study between Nitroglycerin and Magnesium Sulfate during Shoulder Arthroscopic Surgery in the Beach Chair Position

AbstractBackground: This study was designed to compare the efficacy of intravenous infusion of nitroglycerin versus mag-nesium sulfate for controlled hypotensive anesthesia during arthroscopic shoulder surgery in Beach Chair Position (BCP).Aim of Study: To compare the efficacy of nitroglycerin versus magnesium sulfate in inducing deliberate hypotension and satisfactory surgical field in patients undergoing arthro-scopic shoulder surgery.Material and Methods: Fourty patients scheduled for arthroscopic shoulder surgery under general anesthesia in BCP, randomly assigned into two equal groups, nitroglycerin group (NTG group, n=20) received infusion of 0.5-5μg/kg/min and magnesium group (Mg group, n=20) received 40mg/kg, as slow bolus before induction in 100mL saline solution over 10min then 15mg/kg/h by infusion during the operation to achieve a mean arterial blood pressure (MAP) of about 50 to 65mmHg.Results: Controlled hypotension was achieved in both groups. There was no significant difference in MAP between two groups in first 30mins after infusion then magniseum group produced significantly lower MAP values till stopping of infusion. Heart Rate (HR) was significantly lower in mg group compared with the NTG group. More patients required fentanyl consumption intraoperative (p<0.0001) and frequent administration of rocuronium (p=0.001) in NTG group. How-ever, there was longer extubation time and recovery time in Mg group compared with the NTG group. Bleeding score was insignificantly lower in Mg group and surgeon's satisfaction score was significantly better (p=0.035) in the Mg group.Conclusions: Nitroglycerin and magnesium sulfate can effective in achieving hypotensive anesthesia during arthro-scopic shoulder surgery. However, MgSO4 provide a favorable surgical field condition and better surgeon's satisfaction.

Serum magnesium levels during magnesium sulfate infusion at 1 gram/hour versus 2 grams/hour as a maintenance dose to prevent eclampsia in women with severe preeclampsia: A randomized clinical trial.

Background:Magnesium sulfate is the ideal drug for the prevention and treatment of eclampsia. Nevertheless, the best regimen for protection against eclampsia with minimal side effects remains to be established. This study aimed to compare serum magnesium levels during intravenous infusion of magnesium sulfate at 1 gram/hour versus 2 grams/hour as a maintenance dose to prevent eclampsia in pregnant and postpartum women with severe preeclampsia.Methods:A randomized, triple-blind clinical trial was conducted, comparing serum magnesium levels during the intravenous infusion of magnesium sulfate at 1 gram/hour versus 2 grams/hour as a maintenance dose for the prevention of eclampsia in 62 pregnant and postpartum women with severe preeclampsia, 31 in each group. An intravenous loading dose of 6 grams of magnesium sulfate was administered over 30 minutes in both groups. The patients were then randomized to receive a maintenance dose of either 1 or 2 grams/hour for 24 hours. Primary outcomes consisted of serum magnesium levels at the following time points: baseline, 30 minutes, every 2 hours until the end of the first 6 hours, and every 6 hours thereafter until the termination of magnesium sulfate infusion. Side effects, maternal complications, and neonatal outcomes were the secondary outcomes.Results:Serum magnesium levels were higher in the 2-gram/hour group, with a statistically significant difference from 2 hours after the beginning of the magnesium sulfate infusion (P <.05). Oliguria was the most common complication recorded in both groups, with no significant difference between the 2 regimens (RR 0.88; 95% CI: 0.49–1.56; P = .65). No cases of eclampsia occurred. Side effects were more common in the 2-gram/hour group (RR 1.89; 95% CI: 1.04–3.41; P = .02); however, all were mild. There were no differences between the 2 groups regarding neonatal outcomes, except for admission to neonatal intensive care, which was more frequent in the 1-gram/hour group (25% vs 6.3%; P = .04).Conclusion:Magnesium sulfate therapy at the maintenance dose of 1 gram/hour was just as effective as the 2-gram maintenance dose, with fewer side effects.

Effect of the drug combination of magnesium sulfate and phentolamine on homocysteine and C-reactive protein in the serum of patients with pregnancy-induced hypertension syndrome.

Effect and clinical efficacy of magnesium sulfate combined with phentolamine on homocysteine and C-reactive protein in the serum of patients with pregnancy-induced hypertension syndrome were investigated. A total of 96 patients with pregnancy-induced hypertension syndrome who were diagnosed and treated in Jining No. 1 People's Hospital from February 2016 to January 2018 were retrospectively analyzed. The patients were grouped according to the dosage regimen. The patients who received the combination treatment of magnesium sulfate and phentolamine on the basis of magnesium sulfate were included in the observation group, and the patients who were treated with the intravenous infusion of magnesium sulfate alone were included in the control group. Mean arterial pressure (MAP), the content of 24 h urine protein, systolic blood pressure (SBP), diastolic blood pressure (DBP), Hcy, and CRP of the pregnant women were observed. MAP and the content of 24 h urine protein, SBP and DBP of the patients in the observation group after the treatment were significantly lower than those of the patients in the control group (P<0.001). Hcy and CRP of the patients in the observation group after the treatment were significantly lower than those of the patients in the control group (P<0.001). The total effective rate of the patients in the observation group was significantly higher than that of the patients in the control group (P<0.05). In conclusion, the meliorative effect of magnesium sulphate combined with phentolamine on the level of MAP, the content of 24 h urine protein, SBP, DBP, Hcy and CRP in pregnant woman had a greater impact than that of the single use of the intravenous infusion of magnesium sulfate in the treatment of pregnancy-induced hypertension syndrome, and the clinical efficacy of magnesium sulphate combined with phentolamine was better, thus worthwhile to promote widely in clinic.

Intravenous infusion of magnesium sulfate and its effect on horses with trigeminal-mediated headshaking.

BackgroundTrigeminal‐mediated headshaking results from low‐threshold firing of the trigeminal nerve resulting in apparent facial pain. Magnesium may have neuroprotective effects on nerve firing that potentially dampen signs of neuropathic pain. This hypothesis has not been investigated in horses with trigeminal‐mediated headshaking.ObjectiveTo investigate head‐shaking behavior in affected horses after IV magnesium sulfate infusion.AnimalsSix geldings with trigeminal‐mediated headshaking.MethodsProspective randomized crossover study. Horses were controlled for diet and infused IV with 5% dextrose solution (DS; control solution at 2 mL/kg body weight [BW]) and MgSO4 50% solution (MSS at 40 mg/kg BW). Head‐shaking behavior was recorded at times T0 (baseline, before infusion) and T15, T30, T60, and T120 minutes post‐infusion. Venous blood variables such as pH, HCO3 −, standard base excess (SBE), Na+, Cl−, K+, Ca2+, Mg2+, total magnesium (tMg), glucose, and lactate were measured; strong ion difference (SID) and anion gap (AG) were calculated for each time point.ResultsBlood variables including pH, Na+, Cl−, K+, SID, AG, lactate, Ca2+, tMg, and Mg2+ had significant changes with MSS as compared to DS treatment. Glucose, SBE, and HCO3 − did not have significant changes. A 29% reduction in head‐shaking rate occurred after MSS treatment but no change occurred after DS treatment.Conclusions and Clinical ImportanceAdministration of MSS IV increased plasma total and ionized magnesium concentrations and significantly decreased head‐shaking behavior in horses with trigeminal‐mediated headshaking.

Comparative Study between the Effect of Nifedipine, Ritodrine and Magnesium Sulphate Therapy on Doppler Indices of Fetal Umbilical and Middle Cerebral Arteries in Patients with Preterm Labour

Background: Spontaneous preterm labor (SPTL) and preterm birth (PTB), is the single most important cause of perinatal mortality and morbidity in high-income countries despite the enormous efforts over the past several decades. Preterm labor is defined as regular, painful, frequent uterine contractions causing a progressive effacement and dilatation of the cervix occurring before 37 completed weeks of gestation. Many drug therapies were used as tocolytics in cases of preterm labor, however none of them proved to be the best. The present study was performed to compare three of the used drugs for tocolysis to assess their efficacy and side effects on the mother and fetus. Aim: The aim of this study is to compare the effect of oral nifedipine, intravenous ritodrine infusion and magnesium sulfate infusion used as tocolytics in cases of preterm labour on Doppler parameters of fetal umbilical and middle cerebral artery and to evaluate their effects on the mother and the fetus in order to choose the safest and the most effective drug. Methodology: This study was held in the period from December 2014 to october 2015 on 90 patients attended and admitted from the Casualty Unit of the Obstetric Department In Elsayed Glal University Hospital with preterm labor pains , intact membranes, singleton pregnancy between 28 and completed 34 weeks gestation. All patients had been dated accurately with a gestational age based on the last menstrual period and if available a corresponding second trimester ultrasound report performed before 20 weeks gestation. Treatment continued until contractions stopped for 24 hours, maximum doses were attained without response; unacceptable side effects occurred or labor proceeded. Successful treatment was defined as cessation of contractions observed for 24 hours and no further cervical changes. Patients with successful treatment were put under observation for another 24 hours without additional treatment then discharged on no maintenance therapy. Results: Maternal tachycardia, palpitation and dyspnea were more common in the ritodrine group with (p-value = 0.000). The present study showed increase in umbilical artery PI after treatment in the magnesium sulfate group only which was statistically significant (P value = 0.016). The study showed statistically significant increase in middle cerebral artery PI after treatment in magnesium sulfate group with a P value=0.000 and statistically significant decrease in middle cerebral artery with nifedipine group with P value=0.027. When comparing the cerebroplacental ratio before and after treatment in the three groups; the study showed significant increase in cerebroplacental ratio after treatment in the magnesium sulfate group with P value = 0.000, which is statistically significant. This suggests that nifedipine could be used as a safer alternative to ritodrine and magnesium sulfate. Conclusion: In our study, nifedipine therapy was not associated with a significant change in maternal systolic and diastolic blood pressure after 24h, with minor insignificant effect on maternal heart rate. Fetal heart rate was not affected after therapy. Fetal Doppler study found no clinically significant effect on the pulsatility index (PI) of umbilical and middle cerebral artery, while with magnesium sulfate therapy there was increase in cerebro- placental ratio 24hr after treatment, these findings ensure safety of the drugs on the maternal and fetal aspects.

Intravenous magnesium sulphate infusion as first-line therapy in the control of spasms and muscular rigidity in childhood tetanus

ABSTRACTBackground: Reports suggest that, in tetanus, magnesium sulphate (MgSO4) alone may control muscle spasms, thereby avoiding sedation and mechanical ventilation.Aim: To study the efficacy and safety of intravenous MgSO4 in controlling spasms and rigidity in children with tetanus.Methods: All children with tetanus consecutively admitted over a 2-year period in a tertiary-care teaching hospital were recruited. In addition to human tetanus immunoglobulin and parenteral metronidazole, patients received MgSO4 100 mg/kg intravenously followed by infusion at 40 mg/kg/hr. The infusion rate was increased by 5 mg/kg/hr every 6 h until cessation of spasms or abolition of the patellar tendon reflex. Efficacy was determined by control of spasms. Time to commencement of feeds, frequency of autonomic instability, the need for ventilatory support, duration of hospitalisation and mortality were also recorded.Results: Twenty-seven children with tetanus aged between 18 months and 10 years were recruited. A contaminated wound was the most common portal of entry of tetanus spores. The incidences of severity were: grade I, 3; grade II, 7; grades IIIa and b, 17. Rigidity and spasms were controlled by magnesium therapy alone in 14 patients. Additional sedation was required for 13 patients (grade II, 1; grade III, 12). Feeding could be commenced early in five patients. Mechanical ventilation was required in eight patients. The mean (SD) duration of hospitalisation was 26.5 (12.0) days. Five patients died (18.5%). Asymptomatic hypocalcaemia was a universal finding and was treated with calcium supplements.Conclusion: MgSO4 alone is effective in mild-to-moderate tetanus but not when it is severe.

Early-onset neonatal hyperkalemia associated with maternal hypermagnesemia: a case report

BackgroundNeonatal nonoliguric hyperkalemia (NOHK) is a metabolic abnormality that occurs in extremely premature neonates at approximately 24 h after birth and is mainly due to the immature functioning of the sodium (Na+)/potassium (K+) pump. Magnesium sulfate is frequently used in obstetrical practice to prevent preterm labor and to treat preeclampsia; this medication can also cause hypermagnesemia and hyperkalemia by a mechanism that is different from that of NOHK. Herein, we report the first case of very early-onset neonatal hyperkalemia induced by maternal hypermagnesemia.Case presentationA neonate born at 32 weeks of gestation developed hyperkalemia (K+ 6.4 mmol/L) 2 h after birth. The neonate’s blood potassium concentration reached 7.0 mmol/L 4 h after birth, despite good urine output. The neonate and his mother had severe hypermagnesemia caused by intravenous infusion of magnesium sulfate given for tocolysis due to pre-term labor.ConclusionThe early-onset hyperkalemia may have been caused by the accumulation of potassium ions transported through the placenta, the shift of potassium ions from the intracellular to the extracellular space in the infant due to the malfunctioning of the Na+/K+ pump and the inhibition of renal distal tube potassium ion secretion, there is a possibility that these mechanisms were induced by maternal and fetal hypermagnesemia after maternal magnesium sulfate administration. Because neonatal hyperkalemia poses a significant risk for the development of life-threatening cardiac arrhythmia, this case highlights the necessity of maternal blood magnesium monitoring during magnesium sulfate administration and neonatal blood potassium monitoring when there is severe maternal hypermagnesemia at delivery.

Intravenous infusion of magnesium sulfate is not associated with cardiovascular, liver, kidney, and metabolic toxicity in adults

Magnesium (Mg) deficiency contributes to the pathophysiology of numerous diseases. The therapeutic use of Mg has steadily increased over time. The increased in-hospital use of intravenous (IV) magnesium sulfate (MgSO4) warrants more extensive investigation regarding the safety of the therapy. The aim of this study was to determine the safety of IV MgSO4 infusion on cardiovascular, liver, kidney, and metabolic markers in adults. Twelve volunteers were randomized to one of two cross-over conditions: (a) IV infusion of MgSO4 in 5% dextrose followed by IV infusion of 5% dextrose 1 week later or (b) IV infusion of 5% dextrose followed by IV infusion of MgSO4 in 5% dextrose 1 week later. An electrocardiogram was recorded continuously during the infusions. Blood was drawn pre- and post-infusion for blood count (high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides). Results: Serum Mg increased from pre- to post-infusion in the MgSO4 + 5% dextrose group (p < 0.0001). The QRS interval length increased from pre- to post-infusion in the MgSO4 + 5% dextrose group (p < 0.04). Additionally, serum glucose concentration increased in the MgSO4 + 5% dextrose group (p = 0.04). These significant findings were modeled with gender and age as covariates. No other significant differences were found. The administration of IV infusion of MgSO4 (4 g/100 mL) in 5% dextrose over a 4-hour treatment period poses no significant deleterious effects on cardiovascular, liver, kidney, or metabolic function. IV infusion of MgSO4 may be used for certain treatment indications without significant concern for systemic or organ toxicity.

The Effect of Intravenous Infusion of Magnesium Sulfate During Surgery on Pain Reduction After Caesarean Section with Spinal Anesthesia

Background: This study evaluated the effect of infusion of magnesium sulfate during surgery on pain and Parturient morbidity after caesarean section.Methods: In this randomized controlled double-blind clinical trial, 40 pregnant women ASA I, II, who were candidates for caesarean under spinal anesthesia were allocated into two groups by block random methods; the intervention group received magnesium sulfate with 40 mg/kg as loading dose and infusion of 15 mg/kg/h until the end of the surgery and the placebo group received normal saline with similar volume. Pain intensity was measured and recorded by numerical rating scale (NRS) at the baseline (motor block started to wear off) and 30 minutes, 4, 12 and 24 hours later.Results: Magnesium sulfate decreased the mean of blood pressure 3 and 5 minutes after spinal anesthesia and 15 minutes into recovery, decreased the mean of pain intensity (p < 0.001) and painkiller consumption and also reduced the interval before toleration of oral liquids for the time after surgery (10 hours and 53 minutes vs. 13 hours and 6 minutes, p < 0.05). Side effects and the Apgar score of neonates at the first and fifth minutes after delivery had no significant difference between both groups (p < 0.05).Conclusions: Infusion of magnesium sulfate during surgery would decrease pain intensity and postoperative ileus and also would increase the interval before painkiller request by the mother with the least side effects for the mother and the neonate.

A Clinical Comparison between Intrathecal and Intravenous Infusion of Magnesium Sulphate as an Adjuvant to Hyperbaric 0.5% Bupivacaine in Spinal Anaesthesia for Elective Infraumbilical Surgeries

A Clinical Comparison between Intrathecal and Intravenous Infusion of Magnesium Sulphate as an Adjuvant to Hyperbaric 0.5% Bupivacaine in Spinal Anaesthesia for Elective Infraumbilical Surgeries

Por qué la infusión preventiva de una dosis baja de sulfato de magnesio influye en la percepción del dolor postoperatorio y el nivel sérico de beta-endorfinas en las histerectomías abdominales totales

ObjectiveDue to the known role of preventive low dose magnesium sulphate on postoperative pain management, in this randomized, double-blinded, placebo-controlled study, we tried to investigate the possible relationship between low dose intra-operative magnesium sulphate infusion, postoperative analgesia and the level of serum beta-endorphin during total abdominal hysterectomy under general anesthesia. MethodsForty women undergoing total abdominal hysterectomy were randomly allocated into 2 groups (20 in each arm). Fifteen minutes before induction of anaesthesia, the case group received a continuous intravenous infusion of magnesium sulphate (15mg/kg/h) and placebo control group received the same volume of isotonic saline. Pain scores were assessed at 0, 6, 12, and 24h after operations using Verbal Numeric Rating Scale. Pethidine consumption was recorded precisely. Serum level of beta-endorphin just 15min before the induction and at the end of the operations was determined by ELISA technique. ResultsAt 6 and 12h after the operations, Verbal Numeric Rating Scale in the case group was significantly lower than that of placebo control group (P=.0001). Over 24h after the operations, pethidine consumption was significantly lower in the case group compared with control group (P=.0001). In the case group, serum level of beta-endorphin was significantly decreased at the end of the operations compared with before the induction (P=.04). ConclusionWe illustrated that preventive low dose intra-operative magnesium sulphate infusion reduces postoperative pain, has opioid sparing effect and declines serum beta-endorphin concentration during total abdominal hysterectomy.

Effect of intravenous infusion of magnesium sulphate on postoperative analgesia in patients undergoing arthroscopic knee surgeries under spinal anaesthesia

Background: Magnesium sulphate is being used for postoperative pain relief intravenously, intrathecally and epidurally. Currently, it is also gaining popularity as an adjuvant in blocks. The objective of the study was aimed at the postoperative analgesic effects of magnesium sulphate when given as intravenous infusion in patients undergoing arthroscopic knee surgeries under spinal anaesthesia and to compare the postoperative analgesic effects of magnesium sulphate infusion in a study cohort who received magnesium sulphate with the control cohort who were not given magnesium sulphate and underwent arthroscopic knee surgeries under spinal anaesthesia.Methods: After obtaining ethical committee clearance and consent from the patients, 31 patients each were placed in study cohort and control cohort. Spinal anaesthesia was administered in the lateral decubitus position through the L3–4 or L4–5 interspace. Hyperbaric bupivacaine 0.5% solution with fentanyl 20 μg was injected intrathecally. After spinal anaesthesia, patients received magnesium sulphate 50 mg/kg for 15 min and then 15 mg/kg/hr by continuous intravenous infusion until the end of surgery. The other group did not receive magnesium sulphate infusion. Postoperative pain scores and postoperative analgesic consumption were the primary end points.Results: The results of the study reveal the efficacy of perioperative intravenous infusion of magnesium sulphate in prolonging the spinal block as well as reducing the postoperative pain scores without hemodynamic variability or side effects.Conclusions: Post-operative pain and analgesic consumption was reduced with the use of intravenous magnesium following spinal anaesthesia.

Evaluation of effect of intravenous Magnesium Sulfate infusion on tourniquet induced hypertension and pain in arthroscopic knee surgery patients under epidural anesthesia

ObjectiveThis prospective randomized, double blind controlled study was designed to evaluate the effect of Intravenous (i.v) magnesium sulfate infusion on attenuation of tourniquet induced hypertension (TIH) and tourniquet pain and also its effect on postoperative analgesia in patients undergoing arthroscopic knee surgery under epidural anesthesia.Patients and methodsSeventy ASA I and II patients were scheduled for arthroscopic knee surgery with tourniquet under epidural anesthesia. Patients were allocated randomly into two equal groups (n = 35): Magnesium (Mg group) received a bolus dose of IV magnesium sulfate 30 mg/kg in 50 ml saline over 10 min, followed by infusion 10 mg/kg/h and control group received iv saline. Systolic and Diastolic blood pressure (SBP, DBP) and Heart rate (HR) were measured at baseline (before anesthesia), after epidural anesthesia, then every 10 min after the tourniquet inflation, and 1, 5, 10, and 30 min after deflation with recording incidence of (TIH), tourniquet pain, and total iv fentanyl consumption (was given iv 1 ug/kg with tourniquet pain); postoperative Visual Analogue Scale (VAS) score was assessed at 1, 2, 4, 8, 12, 18, and 24 h, postoperative pethidine consumption (given iv 0.5 mg/kg if VAS > 3) was recorded, and serum magnesium was measured preoperatively and at 6 and 24 h postoperatively.ResultsSBP, DBP and HR were significantly higher in the control group than in the Mg group (p < 0.001) after 50 min of inflation. The number of patients who developed TIH and tourniquet pain was significantly lower in Mg group compared to control group 3(8.57%) vs 12(34.28%) (p < 0.05), with significantly shorter time to feel pain in control group 48 ± 8 min versus 71 ± 7 min (p < 0.001). Intraoperative fentanyl requirements were significantly higher in control group compared to Mg group (p < 0.001). Mg group had significantly lower postoperative VAS scores and pethidine consumption (p < 0.001) and significantly longer time to first request of postoperative analgesia compared to control group (p < 0.001). Postoperative serum magnesium was significantly higher in Mg group at 6 h postoperative (p < 0.001).ConclusionIn patients undergoing arthroscopic knee surgery under epidural anesthesia, IV magnesium sulfate in a dose of 30 mg/kg, followed by 10 mg/kg/h infused before tourniquet inflation could reduce TIH, and tourniquet pain with reduction in intraoperative IV fentanyl and postoperative pethidine requirements.

The effect of intravenous magnesium sulfate infusion on reduction of pain after abdominal hysterectomy under general anesthesia: a double-blind, randomized clinical trial.

BackgroundPost-surgical pain is a physiological response to tissue trauma that produces unpleasant physiological effects with manifestations on various organic systems.ObjectiveAccording to the effect of magnesium sulfate on the N-methyl-d-aspartate (NMDA) receptor, this study examined the effect of magnesium sulfate on the reduction of pain and the mean amount of narcotics consumed by patients after abdominal hysterectomies.MethodsThis double-blind clinical trial study was performed on 60 patients who had undergone abdominal hysterectomies in Shahid Sadoughi Hospital in Yazd, Iran, from 2013 to 2015. The patients were divided randomly into two groups of 30 members each. All of the patients received 2 mg of Midazolam and 2 mcg/kg of Fentanyl as the induction of anesthesia with propofol (2–2.5 mg/kg) and Atracurium 0.5 mg/kg was conducted. All of the patients received 5 mg of intravenous morphine 30 min after induction of anesthesia. Afterwards, the study group received 50 mg/kg of magnesium sulfate in 500 cm3 of Ringer’s serum during the 20 minutes, and 500 cm3 of Ringer’s serum was administered to the members of the placebo group. Visual analogue scale VAS scores were evaluated to reach the minimum difference of 0.8 in mean pain scoreResultsThe results of this study indicated that the mean pain scores immediately after surgery and at 1, 2, 6, and 12 hr after surgery were lower in the study group than in the placebo group. The mean value of narcotic consumption at all measured time points was higher in the placebo group. No significant differences were found between two groups concerning drug complications.ConclusionThe results of this study indicated that the intravenous injection of magnesium sulfate can reduce pain, reduce morphine consumption, and reduce the side effects of morphine in patients after surgery.FundingThis study was funded by Shahid Sadoughi University of Medical Sciences, Yazd, IranClinical trial registrationThe trial was registered at the Thai Clinical Trials Registry (http://www.clinicaltrials.in.th) with the registration ID: TCTR20160308001.