Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post-operative analgesic requirements: a prospective, randomized, double-blind, controlled trial in patients undergoing major orthopedic surgery. Export

@article{citeulike:1168650, abstract = {BACKGROUND: New ways of decreasing post-operative analgesic drug requirements are of special interest after major surgery. Magnesium sulfate (MgSO(4)) alters pain processing and reduces the induction and maintenance of central sensitization by blocking the N-methyl-D-aspartate (NMDA) receptor in the spinal cord. We investigated whether supplementation of spinal anesthesia with combined intrathecally and epidurally infused MgSO(4) reduced patients' post-operative analgesia requirements. METHODS: In a randomized, prospective, double-blind, placebo-controlled trial, we enrolled 120 consecutive patients undergoing orthopedic surgery during spinal anesthesia (levobupivacaine and sufentanil). Patients were randomly assigned to receive intrathecal MgSO(4) (94.5 mg, 6.3\%), epidural MgSO(4) (2\%, 100 mg/h), intrathecal and epidural MgSO(4) combined or spinal anesthesia alone (controls). Post-operative morphine consumption was assessed in all groups by patient-controlled analgesia (PCA). RESULTS: Of the 120 patients enrolled, 103 (86\%) completed the study. Morphine consumption at 36 h after surgery was 38\% lower in patients receiving spinal anesthesia plus epidural MgSO(4) [- 14.963 mg; 95\% confidence interval (CI), - 1.44 to - 28.49 mg], 49\% lower in those receiving spinal anesthesia plus intrathecal MgSO(4) (- 18.963 mg; 95\% CI, - 5.27 to - 32.65 mg) and 69\% lower in the intrathecal-epidural combined group (- 26.963 mg; 95\% CI, - 13.73 to - 40.19 mg) relative to control patients receiving spinal anesthesia alone. No complications developed during the post-operative course or at 1 month after surgery. CONCLUSION: In patients undergoing orthopedic surgery, supplementation of spinal anesthesia with combined intrathecal and epidural MgSO(4) significantly reduces patients' post-operative analgesic requirements.}, author = {Arcioni, R. and Palmisani, S. and Tigano, S. and Santorsola, C. and Sauli, V. and Roman\`{o}, S. and Mercieri, M. and Masciangelo, R. and De Blasi, R. A. and Pinto, G.}, citeulike-article-id = {1168650}, citeulike-linkout-0 = {http://dx.doi.org/10.1111/j.1399-6576.2007.01263.x}, citeulike-linkout-1 = {http://www.ingentaconnect.com/content/mksg/aas/2007/00000051/00000004/art00015}, citeulike-linkout-2 = {http://view.ncbi.nlm.nih.gov/pubmed/17378788}, citeulike-linkout-3 = {http://www.hubmed.org/display.cgi?uids=17378788}, doi = {10.1111/j.1399-6576.2007.01263.x}, issn = {0001-5172}, journal = {Acta anaesthesiologica Scandinavica}, keywords = {epidural, magnesium}, month = {April}, number = {4}, pages = {482--489}, posted-at = {2009-10-11 10:17:56}, priority = {2}, publisher = {Blackwell Publishing}, title = {Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post-operative analgesic requirements: a prospective, randomized, double-blind, controlled trial in patients undergoing major orthopedic surgery.}, url = {http://dx.doi.org/10.1111/j.1399-6576.2007.01263.x}, volume = {51}, year = {2007} }

TY - JOUR ID - citeulike:1168650 L3 - citeulike-article-id:1168650 N2 - BACKGROUND: New ways of decreasing post-operative analgesic drug requirements are of special interest after major surgery. Magnesium sulfate (MgSO(4)) alters pain processing and reduces the induction and maintenance of central sensitization by blocking the N-methyl-D-aspartate (NMDA) receptor in the spinal cord. We investigated whether supplementation of spinal anesthesia with combined intrathecally and epidurally infused MgSO(4) reduced patients' post-operative analgesia requirements. METHODS: In a randomized, prospective, double-blind, placebo-controlled trial, we enrolled 120 consecutive patients undergoing orthopedic surgery during spinal anesthesia (levobupivacaine and sufentanil). Patients were randomly assigned to receive intrathecal MgSO(4) (94.5 mg, 6.3%), epidural MgSO(4) (2%, 100 mg/h), intrathecal and epidural MgSO(4) combined or spinal anesthesia alone (controls). Post-operative morphine consumption was assessed in all groups by patient-controlled analgesia (PCA). RESULTS: Of the 120 patients enrolled, 103 (86%) completed the study. Morphine consumption at 36 h after surgery was 38% lower in patients receiving spinal anesthesia plus epidural MgSO(4) [- 14.963 mg; 95% confidence interval (CI), - 1.44 to - 28.49 mg], 49% lower in those receiving spinal anesthesia plus intrathecal MgSO(4) (- 18.963 mg; 95% CI, - 5.27 to - 32.65 mg) and 69% lower in the intrathecal-epidural combined group (- 26.963 mg; 95% CI, - 13.73 to - 40.19 mg) relative to control patients receiving spinal anesthesia alone. No complications developed during the post-operative course or at 1 month after surgery. CONCLUSION: In patients undergoing orthopedic surgery, supplementation of spinal anesthesia with combined intrathecal and epidural MgSO(4) significantly reduces patients' post-operative analgesic requirements. IS - 4 JF - Acta anaesthesiologica Scandinavica SN - 0001-5172 EP - 489 TI - Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post-operative analgesic requirements: a prospective, randomized, double-blind, controlled trial in patients undergoing major orthopedic surgery. PB - Blackwell Publishing VL - 51 SP - 482 KW - epidural KW - magnesium AU - Arcioni, R AU - Palmisani, S AU - Tigano, S AU - Santorsola, C AU - Sauli, V AU - Romanò, S AU - Mercieri, M AU - Masciangelo, R AU - De Blasi, RA AU - Pinto, G PY - 2007/04// UR - http://dx.doi.org/10.1111/j.1399-6576.2007.01263.x ER -