Intrathecal Magnesium for Same-day-surgery

Summary

5% hyperbaric lidocaine has lost its usefulness for same-day-surgery (SDS) anaesthesia because it has been blamed responsible for the so-called transitory neurological syndrome (TNS). This entity appears particularly in patients operated on lithotomy and knee arthroscopy position and obese patients. It is a benign, moderately painful (grade 3-4 out of 10) and self-limited in time, but disturbing enough to be avoided in same-day-surgery cases. Other local anesthetics are not competitive with general anesthesia in time to be discharged home from the SDS unit. The magnesium ion is well-known for its protective properties on cells with electrical activity. The objective is to confirm that the magnesium ion added as adjuvant to intrathecal (IT) lidocaine may antagonize TNS incidence. If this hypothesis could be confirmed, the practical and theoretical consequences would be far-reaching. The method to achieve our objective would be a double-blinded randomized clinical trial considering two groups of intrathecal lidocaine: with and without added IT magnesium.

Timeline

Start

2013-04

Primary completion

2013-12

Completion

2014-03

Publications

• Background Jabalameli M, Pakzadmoghadam SH. Adding different doses of intrathecal magnesium sulfate for spinal anesthesia in the cesarean section: A prospective double blind randomized trial. Adv Biomed Res. 2012;1:7. doi: 10.4103/2277-9175.94430. Epub 2012 May 11.
• Background Nath MP, Garg R, Talukdar T, Choudhary D, Chakrabarty A. To evaluate the efficacy of intrathecal magnesium sulphate for hysterectomy under subarachnoid block with bupivacaine and fentanyl: A prospective randomized double blind clinical trial. Saudi J Anaesth. 2012 Jul;6(3):254-8. doi: 10.4103/1658-354X.101217.
• Background Khezri MB, Yaghobi S, Hajikhani M, Asefzadeh S. Comparison of postoperative analgesic effect of intrathecal magnesium and fentanyl added to bupivacaine in patients undergoing lower limb orthopedic surgery. Acta Anaesthesiol Taiwan. 2012 Mar;50(1):19-24. doi: 10.1016/j.aat.2012.03.001. Epub 2012 Mar 31.
• Background Shukla D, Verma A, Agarwal A, Pandey HD, Tyagi C. Comparative study of intrathecal dexmedetomidine with intrathecal magnesium sulfate used as adjuvants to bupivacaine. J Anaesthesiol Clin Pharmacol. 2011 Oct;27(4):495-9. doi: 10.4103/0970-9185.86594.
• Background Khalili G, Janghorbani M, Sajedi P, Ahmadi G. Effects of adjunct intrathecal magnesium sulfate to bupivacaine for spinal anesthesia: a randomized, double-blind trial in patients undergoing lower extremity surgery. J Anesth. 2011 Dec;25(6):892-7. doi: 10.1007/s00540-011-1227-z. Epub 2011 Sep 18.
• Background Mebazaa MS, Ouerghi S, Frikha N, Moncer K, Mestiri T, James MF, Ben Ammar MS. Is magnesium sulfate by the intrathecal route efficient and safe? Ann Fr Anesth Reanim. 2011 Jan;30(1):47-50. doi: 10.1016/j.annfar.2010.12.005. Epub 2011 Jan 13.
• Background Ouerghi S, Fnaeich F, Frikha N, Mestiri T, Merghli A, Mebazaa MS, Kilani T, Ben Ammar MS. The effect of adding intrathecal magnesium sulphate to morphine-fentanyl spinal analgesia after thoracic surgery. A prospective, double-blind, placebo-controlled research study. Ann Fr Anesth Reanim. 2011 Jan;30(1):25-30. doi: 10.1016/j.annfar.2010.10.018. Epub 2010 Dec 8.
• Background Malleeswaran S, Panda N, Mathew P, Bagga R. A randomised study of magnesium sulphate as an adjuvant to intrathecal bupivacaine in patients with mild preeclampsia undergoing caesarean section. Int J Obstet Anesth. 2010 Apr;19(2):161-6. doi: 10.1016/j.ijoa.2009.08.007. Epub 2010 Feb 18.
• Background Ghrab BE, Maatoug M, Kallel N, Khemakhem K, Chaari M, Kolsi K, Karoui A. [Does combination of intrathecal magnesium sulfate and morphine improve postcaesarean section analgesia?]. Ann Fr Anesth Reanim. 2009 May;28(5):454-9. doi: 10.1016/j.annfar.2009.03.004. Epub 2009 May 7. French.
• Background Unlugenc H, Ozalevli M, Gunduz M, Gunasti S, Urunsak IF, Guler T, Isik G. Comparison of intrathecal magnesium, fentanyl, or placebo combined with bupivacaine 0.5% for parturients undergoing elective cesarean delivery. Acta Anaesthesiol Scand. 2009 Mar;53(3):346-53. doi: 10.1111/j.1399-6576.2008.01864.x. Epub 2009 Jan 23.
• Background Jellish WS, Zhang X, Langen KE, Spector MS, Scalfani MT, White FA. Intrathecal magnesium sulfate administration at the time of experimental ischemia improves neurological functioning by reducing acute and delayed loss of motor neurons in the spinal cord. Anesthesiology. 2008 Jan;108(1):78-86. doi: 10.1097/01.anes.0000296109.04010.82.
• Background Arcioni R, Palmisani S, Tigano S, Santorsola C, Sauli V, Romano S, Mercieri M, Masciangelo R, De Blasi RA, Pinto G. 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. Acta Anaesthesiol Scand. 2007 Apr;51(4):482-9. doi: 10.1111/j.1399-6576.2007.01263.x.
• Background Ozalevli M, Cetin TO, Unlugenc H, Guler T, Isik G. The effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia. Acta Anaesthesiol Scand. 2005 Nov;49(10):1514-9. doi: 10.1111/j.1399-6576.2005.00793.x.
• Background Buvanendran A, McCarthy RJ, Kroin JS, Leong W, Perry P, Tuman KJ. Intrathecal magnesium prolongs fentanyl analgesia: a prospective, randomized, controlled trial. Anesth Analg. 2002 Sep;95(3):661-6, table of contents. doi: 10.1097/00000539-200209000-00031.
• Background Saeki H, Matsumoto M, Kaneko S, Tsuruta S, Cui YJ, Ohtake K, Ishida K, Sakabe T. Is intrathecal magnesium sulfate safe and protective against ischemic spinal cord injury in rabbits? Anesth Analg. 2004 Dec;99(6):1805-1812. doi: 10.1213/01.ANE.0000138039.04548.3D.

Drugs

Indications

No indication recorded.