Skip to main content
SpringerLink
Log in

Does the addition of magnesium to bupivacaine improve postoperative analgesia of ultrasound-guided thoracic paravertebral block in patients undergoing thoracic surgery?

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

Magnesium is a plentiful intracellular cation that has been reported to possess analgesic effect. The present study was aimed to see whether addition of magnesium to bupivacaine in thoracic paravertebral block (TPVB) improved the analgesic effect after thoracic surgery.

Materials and methods

Fifty adult patients undergoing elective open thoracic surgery were divided into two equal groups. Group I received 12 ml of 0.5 % bupivacaine plus 0.9 % saline (3 ml) whereas Group II received 12 ml of 0.5 % bupivacaine plus 150 mg magnesium sulphate (in 3 ml 0.9 % saline) for TPVB. The following parameters were assessed: onset, dermatomal levels and duration of sensory block, duration of analgesia, visual analogue scale (VAS) for pain, postoperative intravenous morphine consumption, pulmonary function tests (peak expiratory flow rate [PEFR], forced expiratory volume in 1 s [FEV1] and forced vital capacity [FVC]) before and 24 h after surgery, and complications from the drugs and technique.

Results

Group II patients showed a significantly longer sensory block duration (224.6 ± 59.3 vs 160.1 ± 55.2 min, P < 0.05), longer duration of analgesia (388.8 ± 70.6 vs 222.2 ± 61.6 min, P < 0.05), less VAS during the postoperative 48 h, less need for postoperative morphine (16.2 ± 7.4 vs 29.5 ± 11.1 mg, P < 0.05) and lower incidence of somnolence (0 [0 %] vs 5 [20 %], P < 0.05). Furthermore, postoperative pulmonary function tests (PEFR, FEV1 and FVC) were significantly better in Group II whereas there was no significant difference between both groups regarding the sensory block dermatomal level or hemodynamic data.

Conclusion

Addition of magnesium to bupivacaine in TPVB improved the analgesic effect of bupivacaine in patients undergoing thoracic surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Karmakar MK. Thoracic paravertebral block. Anesthesiology. 2001;95:771–80.

    Article  CAS  PubMed  Google Scholar 

  2. Davies RG, Myles PS, Graham JM. A comparison of analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy. A systematic review and meta-analysis of randomised trials. Br J Anaesth. 2006;96:418–26.

    Article  CAS  PubMed  Google Scholar 

  3. O Riain SC, Donnell BO, Cuffe T, Harmon DC, Fraher JP, Shorten G. Thoracic paravertebral block using real-time ultrasound guidance. Anesth Analg. 2010; 110:248–51.

    Google Scholar 

  4. Choyce A, Peng P. A systematic review of adjuncts for intravenous regional anesthesia for surgical procedures. Can J Anesth. 2002;49:32–45.

    Article  PubMed  Google Scholar 

  5. Koinig H, Wallner T, Marhofer P, Andel H, Hörauf K, Mayer N. Magnesium sulfate reduces intra-and postoperative analgesic requirements. Anesth Analg. 1998;87:206–10.

    CAS  PubMed  Google Scholar 

  6. 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;95:661–6.

    CAS  PubMed  Google Scholar 

  7. Lee AR, Yi HW, Chung IS, Ko JS, Ahn HJ, Gwak MS, Choi DH, Choi SJ. Magnesium added to bupivacaine prolongs the duration of analgesia after interscalene nerve block. Can J Anesth. 2012;59:21–7.

    Article  PubMed  Google Scholar 

  8. Birbicer H, Doruk N, Cinel I, Atici S, Avlan D, Bilgin E, Oral U. Could adding magnesium as adjuvant to ropivacaine in caudal anesthesia improve postoperative pain control? Pediatr Surg Int. 2007;23:195–8.

    Article  CAS  PubMed  Google Scholar 

  9. Kotzé A, Scally A, Howell S. Efficacy and safety of different techniques of paravertebral block for analgesia after thoracotomy: a systematic review and meta regression. Br J Anaesth. 2009;103:626–36.

    Article  PubMed  Google Scholar 

  10. Ishizaki K, Sasaki M, Karasawa S, Obata H, Nara T, Goto F. The effect of intrathecal magnesium sulphate on nociceptin in rat acute pain models. Anaesthesia. 1999;54:241–6.

    Article  CAS  PubMed  Google Scholar 

  11. Haubold HA, Meltzer SJ. Spinal anesthesia by magnesium sulfate. JAMA. 1906;46:647–50.

    Article  Google Scholar 

  12. Chanimov M, Cohen ML, Grinspun Y, Herbert M, Reif R, Kaufman I, Bahar M. Neurotoxicity after spinal anaesthesia induced by serial intrathecal injections of magnesium sulphate: an experimental study in a rat model. Anaesthesia. 1997;52:223–8.

    Article  CAS  PubMed  Google Scholar 

  13. Lejuste MJLR. Inadvertent intrathecal administration of magnesium sulfate. S Afr Med J. 1985;68:367–8.

    CAS  PubMed  Google Scholar 

  14. Miranda HF, Bustamante D, Kramer V, Pelissier T, Saavedra H, Paeile C, Fernandez E, Pinardi G. Antinociceptive effects of Ca2+ channel blockers. Eur J Pharmacol. 1992;217:137–41.

    Article  CAS  PubMed  Google Scholar 

  15. Dickenson AH. A cure for wind up: NMDA receptor antagonists as potential analgesics. Trends Pharmacol Sci. 1990;11:307–9.

    Article  CAS  PubMed  Google Scholar 

  16. Woolf CJ, Thompson SW. The induction and maintenance of central sensitization is dependent on N-methyl-d-aspartate acid receptor activation; implication for the treatment of post-injury pain hypersensitivity states. Pain. 1991;44:293–9.

    Article  CAS  PubMed  Google Scholar 

  17. Liu HT, Hollmann MW, Liu WH, Hoenemann CW, Durieux ME. Modulation of NMDA receptor function by ketamine and magnesium. Anesth Analg. 2001;92:1173–81.

    Article  CAS  PubMed  Google Scholar 

  18. Ghatak T, Chandra G, Malik A, Singh D, Bhatia VK. Evaluation of the effect of magnesium sulphate vs. clonidine as adjunct to epidural bupivacaine. Indian J Anaesth. 2010;54:308–13.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Birbicer H, Cinel I, Doruk N, Avlan D, Atici S, Bilgin E, Serinol H, Oral U. The effects of caudal magnesium administration on anaesthesia depth and analgesia requirement. Eur J Anaesthesiol. 2004;21:150–4.

    Article  Google Scholar 

  20. Dehghani SN, Bigham AS. Comparison of caudal epidural anesthesia by use of lidocaine versus a lidocaine–magnesium sulfate combination in cattle. Am J Vet Res. 2009;70:194–7.

    Article  CAS  PubMed  Google Scholar 

  21. Gunduz A, Bilir A, Gulec S. Magnesium added to prilocaine prolongs the duration of axillary plexus block. Reg Anesth Pain Med. 2006;31:233–6.

    CAS  PubMed  Google Scholar 

  22. Narang S, Dali JS, Agarwal M, Garg R. Evaluation of the efficacy of magnesium sulphate as an adjuvant to lignocaine for intravenous regional anaesthesia for upper limb surgery. Anaesth Intensive Care. 2008;36:840–4.

    CAS  PubMed  Google Scholar 

  23. Vogt A, Stieger DS, Theurillat C, Curatolo M. Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery. Br J Anaesth. 2005;95:816–21.

    Article  CAS  PubMed  Google Scholar 

  24. Richardson J, Sabanathan S, Jones J, Shah RD, Cheema S, Mearns AJ. A prospective, randomized comparison of preoperative and continuous balanced epidural or paravertebral bupivacaine on post-thoracotomy pain, pulmonary function and stress responses. Br J Anaesth. 1999;83:387–92.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Faculty of Medicine, Minoufiya University, Egypt. Minoufiya University is funding the research

Author information

Authors and Affiliations

  1. Faculty of Medicine, Minoufiya University, 3 Yaseen Abdel-Ghaffar st., Shebin Elkoam, Minoufiya, Egypt

    Amany S. Ammar & Khaled M. Mahmoud

Authors
  1. Amany S. Ammar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Khaled M. Mahmoud
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Khaled M. Mahmoud.

About this article

Cite this article

Ammar, A.S., Mahmoud, K.M. Does the addition of magnesium to bupivacaine improve postoperative analgesia of ultrasound-guided thoracic paravertebral block in patients undergoing thoracic surgery?. J Anesth 28, 58–63 (2014). https://doi.org/10.1007/s00540-013-1659-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-013-1659-8

Keywords

Search

Navigation