Journal of Anesthesia

, Volume 23, Issue 1, pp 19–25 | Cite as

Effects of adding magnesium to bupivacaine and fentanyl for spinal anesthesia in knee arthroscopy

  • Hüban Dayioǧlu
  • Zehra N. Baykara
  • Asena Salbes
  • Mine Solak
  • Kamil Toker
Original Article



The aim of the study was to investigate the effects of adding intrathecal magnesium sulfate 50 mg to low-dose bupivacaine-fentanyl on the spread, duration, regression of spinal block, and postoperative analgesia in patients undergoing knee arthroscopy.


This study was designed in a prospective, randomized, and double-blinded manner. Sixty American Society of Anesthesiologists (ASA) physical status I or II patients were randomly allocated to receive 50 mg magnesium sulfate (3 ml) or 3 ml of preservative-free 0.9% NaCl following 6 mg bupivacaine 0.5% plus 10 μg fentanyl intrathecally. Date were collected regarding the highest level of dermatomal sensory blockade, the time to reach this level from the time of injection of the spinal anesthetic, Bromage scale of motor blockade at the time of reaching maximum sensory level, time for regression of two segments in the maximum block height, time to L2 regression, time to ambulation, and postoperative analgesic consumption.


The addition of intrathecal magnesium (50 mg) to spinal anesthesia prolonged the time for regression of two segments in the maximum block height and time to L2 regression, but did not affect maximum sensory level or the time to reach the highest level of sensory block. Even though the mean times to complete recovery of motor function were similar in the two groups, time to ambulation was significantly longer in the magnesium group than in the saline group. Total analgesic consumption in the first 24 h was not decreased significantly with the addition of magnesium to spinal anesthesia, but the time to first analgesic requirement was prolonged significantly.


Even though the time to first analgesic requirement was prolonged significantly by magnesium, the addition of intrathecal magnesium sulfate to spinal anesthesia is not desirable in patients undergoing knee arthroscopy due to the prolonged time to ambulation and the lack of effect of magnesium on postoperative analgesic consumption.

Key words

Anesthetic techniques Intrathecal Drugs Magnesium sulfate Bupivacaine Fentanyl 


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  1. 1.
    Ben-David B, Solomon E, Levin H, Admoni H, Goldik Z. Intrathecal fentanyl with small dose dilute bupivacaine: better anesthesia without prolonging recovery. Anesth Analg. 1997;85:560–565.PubMedCrossRefGoogle Scholar
  2. 2.
    Parnass SM, McCarthy RJ, Bach BR Jr, Corey ER, Hasson S, Werling MA, Ivankovich AD. Beneficial impact of epidural anesthesia on recovery after outpatient arthroscopy. Arthroscopy. 1993;9:91–95.PubMedGoogle Scholar
  3. 3.
    Jacopson E, Forssblad M, Rosenberg J, Westman L, Weidenhielm L. Can local anesthesia be recommended for routine use in elective knee arthroscopy? A comparison between local, spinal, and general anesthesia. Arthroscopy. 2000;16:183–190.Google Scholar
  4. 4.
    Jankowsy CJ, Helb JR, Stuart MJ, Rock MG, Pagnano MW, Beighley CM, Schroeder DR, Horlocker TT. A comparison of psoas compartment block and spinal and general anesthesia for outpatient knee arthroscopy. Anesth Analg. 2003;97:1003–1009.CrossRefGoogle Scholar
  5. 5.
    Mulroy MF, Larkin KL, Hodgson PS, Helman JD, Pollock JE, Liu SS. A comparison of spinal, epidural, and general anesthesia for outpatient knee arthroscopy. Anesth Analg. 2000;91:860–864.PubMedCrossRefGoogle Scholar
  6. 6.
    Wong B, Marshall S, Chung F, Sinclair D, Song D, Tong D. Spinal anesthesia improves the early recovery profile of patients undergoing knee arthroscopy. Can J Anaesth. 2001;48:369–374.PubMedGoogle Scholar
  7. 7.
    Korhonen AM, Valanne JV, Jokela RM, Ravaska, P, Kortilla K. Intrathecal hyperbaric bupivacaine 3 mg+fentany1 10 μg for outpatient arthroscopy with tourniquet. Acta Anaesthesiol Scand. 2003;47:342–346.PubMedCrossRefGoogle Scholar
  8. 8.
    Borghi B, Stagni F, Bugamelli S, Paini MB, Nepoti ML, Montebugnoli M, Casati A. Unilateral spinal block for outpatient knee arthroscopy: a dose finding study. J Clin Anesth. 2003;15:351–356.PubMedCrossRefGoogle Scholar
  9. 9.
    Kawamata YT, Nishikawa K, Kawamata T, Omote T, Igarashi M, Yamauchi M, Sato K, Nakayama M, Namiki A. A comparison of hyperbaric 1% and 3% solutions of small dose lidocaine in spinal anaesthesia. Anesth Analg. 2003;96:881–884.PubMedCrossRefGoogle Scholar
  10. 10.
    Pullock JE, Mulroy MF, Bent E, Polissar NL. A comparison of two regional anesthetic techniques for outpatient knee arthroscopy. Anesth Analg. 2003;97:397–401.CrossRefGoogle Scholar
  11. 11.
    Woolf CJ, Thompson SW. The induction and maintenance of central sensitization is dependent on N-methyl-D aspartic acid receptor activation; implications for the treatment of post-injury pain and hypersensitivity states. Pain. 1991;44:293–299.PubMedCrossRefGoogle Scholar
  12. 12.
    Woolf CJ, Chong MS. Preemptive analgesia: treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993;77:362–379.PubMedCrossRefGoogle Scholar
  13. 13.
    Menigaux C, Guignard B, Fletcher D, Sessler DI, Dupont X, Chauvin M. Intraoperative small dose ketamine enhances analgesia after outpatient knee arthroscopy. Anesth Analg. 2001;93:606–612.PubMedCrossRefGoogle Scholar
  14. 14.
    Ko SH, Lim HR, Kim DC, Han YJ, Choe H, Song HS. Magnesium sulphate does not reduce postoperative analgesic requirements. Anesthesiology. 2001;95:640–646.PubMedCrossRefGoogle Scholar
  15. 15.
    Kroin JS, McCarthy RJ, Von Roenn N, Schwab B, Tuman KJ, Ivankovich AD. Magnesium sulfate potentiates morphine antinociception at the spinal level. Anesth Analg. 2000;90:913–917.PubMedCrossRefGoogle Scholar
  16. 16.
    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;95:661–666.PubMedCrossRefGoogle Scholar
  17. 17.
    Arcioni R, Palmisani S, Santorsola C, Sauli V, Romano S, Mercieri M, Masciangelo R. 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;51:482–489.PubMedCrossRefGoogle Scholar
  18. 18.
    Ozalevli M, Cetin TO, Unlugence H, Guler T, Isik G. The effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia. Acta Anaesthesiol Scand. 2005;49:1514–1519.PubMedGoogle Scholar
  19. 19.
    Gürkan Y, Canatay H, Özdamar D, Solak M, Toker K. Spinal anesthesia for arthroscopic knee surgery. Acta Anaesth Scand. 2004;48:513–517.PubMedCrossRefGoogle Scholar
  20. 20.
    Ishizaki K, Sasaki M, Karasawa S, Obata H, Nara T, Goto F. The effect of intrathecal magnesium sulphate on nociception in rat acute pain models. Anaesthesia. 1999;54:241–246.PubMedCrossRefGoogle Scholar
  21. 21.
    Zahn PK, Brennan TJ. Lack of effect of intrathecally administered N-methyl-D aspartate receptor antagonists in a rat model for postoperative pain. Anesthesiology. 1998;88:43–56.CrossRefGoogle Scholar
  22. 22.
    Zahn PK, Brennan TJ. Primary and secondary hyperalgesia in a rat model for human postoperative pain. Anesthesiology. 1999;90:863–872.PubMedCrossRefGoogle Scholar
  23. 23.
    Pogatzky EM, Zahn PK, Brenna TJ. Effect of pretreatment with intrathecal excitatory amino acid receptor antagonists on the development of pain behaviour caused by plantar incision. Anesthesiology. 2000;93:489–496.CrossRefGoogle Scholar
  24. 24.
    Bacigalupo G, Riese S, Rosendahl H, Saling E. Quantitative relationships between pain intensities during labor and beta-endorphin and cortisol concentrations in plasma: decline of the hormone concentrations in the early postpartum period. J Perinat Med. 1990;18:289–296.PubMedGoogle Scholar
  25. 25.
    Imarengiaye CO, Song D, Prabhu AJ, Chung F. Spinal anesthesia: functional balance is impaired after clinical recovery. Anesthesiology. 2003;98:511–515.PubMedCrossRefGoogle Scholar
  26. 26.
    Buggy D, Hughes N, Gardiner J. Posterior column somatosensory impairment during ambulatory extradural analgesia in labour. Br J Anaesth. 1994;73:540–542.PubMedCrossRefGoogle Scholar
  27. 27.
    Knoerl DV, McNulty P, Estes C, Conley K. Evaluation of orthostatic blood pressure as a discharge criteria from PACU after spinal anesthesia. J Perianesth Nurs. 2001;16:11–18.PubMedGoogle Scholar
  28. 28.
    Fassoulaki A, Sarantopoulus C, Zotou M, Karabinis G. Assessment of the level of sensory block after subarachnoid anesthesia using a pressure palpator. Anesth Analg. 1999;88:398–401.PubMedCrossRefGoogle Scholar
  29. 29.
    Shah J, Ayorinde BT, Rowbotham DJ, Buggy DJ. Warm air sensation for assessment of block after spinal anaesthesia. Br J Anaesth. 2000;84:399–400.PubMedGoogle Scholar
  30. 30.
    Chanimov M, Cohen ML, Grinspun Y, Herbert M, Reif R, Kaufman I, Bahar M. Neurotoxicity after spinal anesthesia induced by serial intrathecal injections of magnesium sulphate: an experimental study in a rat model. Anaesthesia. 1997;52:223–228.PubMedCrossRefGoogle Scholar
  31. 31.
    Simpson JI, Eide TR, Schiff GA, Clagnaz JF, Hossain I, Tverskoy A, Koski G. Intrathecal magnesium sulphate protects the spinal cord from ischemic injury during thoracic aortic cross clamping. Anesthesiology. 1994:81:1493–1499.PubMedCrossRefGoogle Scholar
  32. 32.
    Haubold HA, Meltzer SJ. Spinal anesthesia by magnesium sulfate. JAMA. 1906;46:647–650.Google Scholar
  33. 33.
    Lejuste MJ. Inadvertent intrathecal administration of magnesium sulfate. S Afr Med J. 1985;68:367–368.PubMedGoogle Scholar
  34. 34.
    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;99:6.1805–6.1812.Google Scholar

Copyright information

© Japanese Society of Anesthesiologists 2009

Authors and Affiliations

  • Hüban Dayioǧlu
    • 1
  • Zehra N. Baykara
    • 1
    • 2
  • Asena Salbes
    • 1
  • Mine Solak
    • 1
  • Kamil Toker
    • 1
  1. 1.Department of Anesthesiology, Faculty of MedicineUniversity of KocaeliKocaeliTurkey
  2. 2.Tubitak MAM Loj.KocaeliTurkey

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