Korean J Pain.  2017 Jul;30(3):207-213. 10.3344/kjp.2017.30.3.207.

The impact of magnesium sulfate as adjuvant to intrathecal bupivacaine on intra-operative surgeon satisfaction and postoperative analgesia during laparoscopic gynecological surgery: randomized clinical study

• Mohamed KS
• Abd-Elshafy SK
• El Saman A

• KMID: 2385353
• DOI: http://doi.org/10.3344/kjp.2017.30.3.207

Abstract

BACKGROUND
Surgeon satisfaction and patient analgesia during the procedure of laparoscopic surgery are important issues. The aim of this work was to study if an intrathecal (IT) Bupivacaine combined with Magnesium sulfate may or may not provide good surgeon satisfaction in addition to improvement of intraoperative and postoperative analgesia.
METHODS
Sixty female patients were enrolled in this prospective, randomized, double-blind controlled clinical trial study. All patients were operated for gynecological laparoscopic surgery under spinal anesthesia. Patients were divided into two groups (Bupivacaine and Magnesium). Group Bupivacaine (30 patients) received intrathecal Bupivacaine 0.5% only (15 mg), while 30 patients in group Magnesium received intrathecal Bupivacaine (15 mg) in addition to intrathecal Magnesium sulfate (50 mg). The sensory block level, the intensity of motor block, the surgeon satisfaction, the intraoperative visual analog scale (VAS) for pain assessment, the postoperative VAS, and side effects were recorded during the intraoperative period and within the first 24 hours after surgery in the post-anesthesia care unit.
RESULTS
Surgeon satisfaction, intraoperative shoulder pain, postoperative pain after 2 h, and perioperative analgesic consumption (ketorolac) were significant better in group Magnesium than in group Bupivacaine. (P < 0.05). The onset of motor and sensory blocks was significant longer in group Magnesium than the other one. The incidence of PONV, pruritus and urinary retention was insignificant statistically between both groups.
CONCLUSIONS
Magnesium sulfate if used intrathecally as an adjuvant to Bupivacaine would provide a better surgeon satisfaction and would improve the analgesic effect of spinal anesthesia used for gynecological laparoscopic surgery.

Keyword

Bupivacaine; Laparoscopic surgery; Magnesium; Postoperative pain; Satisfaction; Surgeon

MeSH Terms

Analgesia*
Anesthesia, Spinal
Bupivacaine*
Clinical Study*
Female
Gynecologic Surgical Procedures*
Humans
Incidence
Intraoperative Period
Laparoscopy
Magnesium Sulfate*
Magnesium*
Pain Measurement
Pain, Postoperative
Postoperative Nausea and Vomiting
Prospective Studies
Pruritus
Shoulder Pain
Urinary Retention
Visual Analog Scale
Bupivacaine
Magnesium
Magnesium Sulfate

Figure

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  Fig. 1 CONSORT Flow Diagram. Group B: Group Bupivacaine, Group Mg: Group Magnesium.

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  Fig. 2 Surgeon satisfaction, Shoulder pain and Total dose of ketorolac used intra-operatively in both groups. VAS: visual analougue scale. *P-value < 0.05 by using independent t-test.

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  Fig. 3 Postoperative VAS in both groups, median (Interquartile range). *P-value < 0.05 by using -Whitney test.

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