Adding Magnesium Sulphate and Dexamethasone in Bupivacaine Femoral Nerve Block for Postoperative Analgesia in Elective Total Knee Arthroplasty
Keywords:
magnesium sulphate, dexamethasone, bupivacaine, femoral nerve block, total knee arthroplastyAbstract
Background: Total knee arthroplasty is usually a very painful procedure. A single-dose of femoral nerve block has been shown to be useful and effective in controlling postoperative pain, especially if perineural
adjuvants are added.
Methods: A total of 100 ASA physical status I – III patients undergoing elective TKA under spinal anesthesia were randomly allocated into two equal groups, Group D : given 20 ml Bupivacaine 0.25% with 8 mg
dexamethasone. Group DM : given 20 ml Bupivacaine 0.25% with 8 mg dexamethasone and 1 g magnesium sulphate, through femoral catheter. Patient characteristics, operative time, pain score, morphine consumption and duration of sensory/motor blockade were recorded.
Results: The study showed a significantly lower pain scores in first 6 hours, with a significantly lower in cumulative morphine consumptions in first 12 hours in DM group. There was no different in demographic data, operative time and duration of sensory/motor blockade between groups.
Conclusion: Perineural magnesium sulphate and dexamethasone improve postoperative pain outcomes in bupivacaine femoral nerve block.
References
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2. Ashraf Abd E, Ahmed B, Samaa Abu E, Doaa R. Effect of addition of magnesium sulphate and fentanyl to ropivacaine continuous femoral nerve block in patients undergoing elective total knee replacement. Journal of Medical
Sciences 2008; 8: 395-39.
3. Kirksey MA, Haskins SC, Cheng J, Liu SS. Local anesthetic peripheral nerve block adjuvants for prolongation of analgesia: a systematic qualitative review. PLoS ONE 2015; 10:e0137312.
4. Desmet M, Braems H, Reynvoet M, I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: a prospective, randomized,
placebo-controlled study. Br J Anaesth 2013;111:445-452.
5. Sheriff AA, Elsersy HE. Dexamethasone as adjuvant for femoral nerve block following knee arthroplasty: a randomized, controlled study. Acta Anaesthesiol Scand 2016; 60: 977-87.
6. Ortiz-Gómez JR, Perepérez-Candel M, Vázquez-Torres JM, Rodriguez-Del Río JM, Torrón-Abad B, Fornet-Ruiz I, et al. Postoperative analgesia for elective total knee arthroplasty under subarachnoid anesthesia with opioids: comparison
between epidural, femoral block and adductor canal block techniques (with and without perineural adjuvants). A prospective, randomized, clinical trial. Minerva Anestesiologica 2017; 83: 50-8.
7. Morales-Muñoz C, Sánchez-Ramos JL, Díaz-Lara MD, González-González J, Gallego-Alonso I, Hernández-Del-Castillo MS. Analgesic effect of a single-dose of perineural dexamethasone on ultrasound-guided femoral nerve block after
total knee replacement. Rev Esp Anestesiol Reanim 2017;64:19-26.
8. KG Gordon, S Choi, RN Rodseth. The role of dexamethasone in peripheral and neuraxial nerve blocks for the management of acute pain. Southern African Journal of Anaesthesia and Analgesia 2016; 22: 163-9.
9. Gildasio S Jr, Lucas J, Castro A, Autoun N, Mark CK, Rohit R, Robert JM. Perineural dexamethasone to improve postoperative analgesia with peripheral nerve blocks: a meta-analysis of randomized controlled trials. Pain Research
and Treatment 2014. https://dx.doi.org/10.1155/2014/179029
10. Hala EA, Khaled AE, Sherif MS, Mohammed MA, Kareem MN. Perineural dexamethasone prolongs the duration of combined femoral and sciatic nerve block in lower limb vascular surgeries: a prospective randomized trial. Med. J.
Cairo Univ 2016; 84: 1367-75.
11. Hossam AE, Mohamed I, Hossam IE. Magnesium sulfate in femoral nerve block, does postoperative analgesia differ? A comparative study. Egyptian Journal of Anaesthesia 2014; 30: 169-73.
12. Karon M, Emily P. The use of calcium and magnesium to prevent neurotoxicity in patients receiving oxaliplatin. J Adv Pract Oncol 2015; 6: 266–270.
13. Koinig H, Wallner T, Marhofer P, Magnesium sulphate reduces intra and postoperative analgesic requirement. Anesth Analg 1998;87:206–10.
14. Ryu JH, Kang MH, Park KS, Effects of magnesium sulphate on intraoperative anesthetic requirements and postoperative analgesia in gynecology patients receiving total intravenous anesthesia. Br J Anesth 2008;100:397–402.
15. Ozcan PE, Tugrul S, Senturk NM, Role of magnesium sulphate in postoperative pain management for patients undergoing thoracotomy. J Cardiothor Vasc Anesth 2007;21:827–31.
16. Sirvinskas E, Laurinaitis R. Use of Magnesium sulphate in Anesthesiology. Medicina 2002;38:147–50.
17. Tramer MR, Scheneider J, Role of Magnesium sulphate in postoperative analgesia. Anesthesiology 1996;8:340–7.
18. Levaux CH, Bonhomme V, Effect of intraoperative magnesium sulphate on pain relief and patient comfort after major lumbar orthopedic surgery. Anesthesia 2003;68: 131–5.
19. Koo BN, Kil HK, The clinical effects of intrathecal Mgso4 on spinal anesthesia and postoperative epidural analgesia in total knee replacement. Reg Anesth Pain Med 2004;29:11–3.
20. James MF. Clinical use of magnesium infusions in anesthesia.Anesth Analg 1992;74:129–37.
21. Aytac G, Ayten B, Sacit G. Magnesium added to Prilocaine prolongs the duration of Axillary Plexus block. Reg Anesth Pain Med 2006;31:233–6.
22. Mukherjee K, Das A, Basunia S. Evaluation of Magnesium as an adjuvant in Ropivacaine-induced supraclavicular brachial plexus block: A prospective, double-blinded randomized controlled study. J Res Pharm Pract. 2014 OctDec; 3: 123–129.
23. Hung YC, Chen CY, Magnesium sulphate diminishes the effects of amide local anesthetics in rat sciatic nerve block. Reg Anesth Pain Med 2007;32:288–95.
24. Bondok RS, Abd El-Hady AM. Intra-articular magnesium is effective for postoperative analgesia in arthroscopic knee surgery. Br J Anesth 2006;97:389–92.
25. Kashefi P, Montazeri K, Adding magnesium sulphate to lidocaine for intravenous regional anesthesia. Reg Anesth Pain Med 2008;33:97.
2. Ashraf Abd E, Ahmed B, Samaa Abu E, Doaa R. Effect of addition of magnesium sulphate and fentanyl to ropivacaine continuous femoral nerve block in patients undergoing elective total knee replacement. Journal of Medical
Sciences 2008; 8: 395-39.
3. Kirksey MA, Haskins SC, Cheng J, Liu SS. Local anesthetic peripheral nerve block adjuvants for prolongation of analgesia: a systematic qualitative review. PLoS ONE 2015; 10:e0137312.
4. Desmet M, Braems H, Reynvoet M, I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: a prospective, randomized,
placebo-controlled study. Br J Anaesth 2013;111:445-452.
5. Sheriff AA, Elsersy HE. Dexamethasone as adjuvant for femoral nerve block following knee arthroplasty: a randomized, controlled study. Acta Anaesthesiol Scand 2016; 60: 977-87.
6. Ortiz-Gómez JR, Perepérez-Candel M, Vázquez-Torres JM, Rodriguez-Del Río JM, Torrón-Abad B, Fornet-Ruiz I, et al. Postoperative analgesia for elective total knee arthroplasty under subarachnoid anesthesia with opioids: comparison
between epidural, femoral block and adductor canal block techniques (with and without perineural adjuvants). A prospective, randomized, clinical trial. Minerva Anestesiologica 2017; 83: 50-8.
7. Morales-Muñoz C, Sánchez-Ramos JL, Díaz-Lara MD, González-González J, Gallego-Alonso I, Hernández-Del-Castillo MS. Analgesic effect of a single-dose of perineural dexamethasone on ultrasound-guided femoral nerve block after
total knee replacement. Rev Esp Anestesiol Reanim 2017;64:19-26.
8. KG Gordon, S Choi, RN Rodseth. The role of dexamethasone in peripheral and neuraxial nerve blocks for the management of acute pain. Southern African Journal of Anaesthesia and Analgesia 2016; 22: 163-9.
9. Gildasio S Jr, Lucas J, Castro A, Autoun N, Mark CK, Rohit R, Robert JM. Perineural dexamethasone to improve postoperative analgesia with peripheral nerve blocks: a meta-analysis of randomized controlled trials. Pain Research
and Treatment 2014. https://dx.doi.org/10.1155/2014/179029
10. Hala EA, Khaled AE, Sherif MS, Mohammed MA, Kareem MN. Perineural dexamethasone prolongs the duration of combined femoral and sciatic nerve block in lower limb vascular surgeries: a prospective randomized trial. Med. J.
Cairo Univ 2016; 84: 1367-75.
11. Hossam AE, Mohamed I, Hossam IE. Magnesium sulfate in femoral nerve block, does postoperative analgesia differ? A comparative study. Egyptian Journal of Anaesthesia 2014; 30: 169-73.
12. Karon M, Emily P. The use of calcium and magnesium to prevent neurotoxicity in patients receiving oxaliplatin. J Adv Pract Oncol 2015; 6: 266–270.
13. Koinig H, Wallner T, Marhofer P, Magnesium sulphate reduces intra and postoperative analgesic requirement. Anesth Analg 1998;87:206–10.
14. Ryu JH, Kang MH, Park KS, Effects of magnesium sulphate on intraoperative anesthetic requirements and postoperative analgesia in gynecology patients receiving total intravenous anesthesia. Br J Anesth 2008;100:397–402.
15. Ozcan PE, Tugrul S, Senturk NM, Role of magnesium sulphate in postoperative pain management for patients undergoing thoracotomy. J Cardiothor Vasc Anesth 2007;21:827–31.
16. Sirvinskas E, Laurinaitis R. Use of Magnesium sulphate in Anesthesiology. Medicina 2002;38:147–50.
17. Tramer MR, Scheneider J, Role of Magnesium sulphate in postoperative analgesia. Anesthesiology 1996;8:340–7.
18. Levaux CH, Bonhomme V, Effect of intraoperative magnesium sulphate on pain relief and patient comfort after major lumbar orthopedic surgery. Anesthesia 2003;68: 131–5.
19. Koo BN, Kil HK, The clinical effects of intrathecal Mgso4 on spinal anesthesia and postoperative epidural analgesia in total knee replacement. Reg Anesth Pain Med 2004;29:11–3.
20. James MF. Clinical use of magnesium infusions in anesthesia.Anesth Analg 1992;74:129–37.
21. Aytac G, Ayten B, Sacit G. Magnesium added to Prilocaine prolongs the duration of Axillary Plexus block. Reg Anesth Pain Med 2006;31:233–6.
22. Mukherjee K, Das A, Basunia S. Evaluation of Magnesium as an adjuvant in Ropivacaine-induced supraclavicular brachial plexus block: A prospective, double-blinded randomized controlled study. J Res Pharm Pract. 2014 OctDec; 3: 123–129.
23. Hung YC, Chen CY, Magnesium sulphate diminishes the effects of amide local anesthetics in rat sciatic nerve block. Reg Anesth Pain Med 2007;32:288–95.
24. Bondok RS, Abd El-Hady AM. Intra-articular magnesium is effective for postoperative analgesia in arthroscopic knee surgery. Br J Anesth 2006;97:389–92.
25. Kashefi P, Montazeri K, Adding magnesium sulphate to lidocaine for intravenous regional anesthesia. Reg Anesth Pain Med 2008;33:97.
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Published
13-07-2019
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ธัญญาวินิชกุล ข., หว่องประเสริฐ ข., & จิตต์มาลา น. (2019). Adding Magnesium Sulphate and Dexamethasone in Bupivacaine Femoral Nerve Block for Postoperative Analgesia in Elective Total Knee Arthroplasty. Journal of Nakornping Hospital, 8(1). Retrieved from https://he01.tci-thaijo.org/index.php/jnkp/article/view/203104
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