Comparison Of Magnesium Sulphate With Dexamethasone As Adjuvant To Local Anaesthetics For Supraclavicular Brachial Plexus Block

Background:Background and objectives: Brachial plexus block is routinely performed method of regional nerve block. Different adjuvantshave been used to hasten the onset and prolong the duration of peripheral nerve blocks. In this study we compared dexamethasone and magnesium sulphate as an adjuvant to combination of bupivacaine and lignocaine in supraclavicular brachial plexus block with regards to comparison of time required for onset and duration of sensory and motor block, duration of post-operative analgesia and requirement of rescue analgesics in first 24 hours postoperatively. Material And Methods:This prospective, observational, comparative study was performed on 60 patients of ASA class I, II and III in the age group of 18 to 70 years, weighing 40 to 70 kilogram and undergoing lower arm, elbow, forearm and hand surgeriesdivided in to 2 equal groups D and M. Group D received dexamethasone 8mg and group M received magnesium sulphate 500mg along with bupivacaine(0.5%) and lignocaine(2%).Result:Onest of sensory and motor blockade was significantly faster in group D compared to group M (p-0.001, p<0.001 respectively). Duration of sensory and motor blockade and duration of postoperative analgesia was prolonged in group D compared to group M (p-0.008, p-0.034).Conclusion:Addition of dexamethasone or magnesium sulphate as adjuvant in supraclavicular block prolongs postoperative analgesia. Dexamethasone provided quicker onset and longer duration of analgesia with lesser consumption of rescue analgesic in comparison to magnesium sulphate.

Periarticular Infiltration (Bupivacaine, Adrenaline, Magnesium Sulphate And Dexmedetomidine) For Postoperative Analgesia In Total Knee Arthroplasty- A Cases Series Study

Background:Total knee arthroplasty is a major surgery associated with severe pain and delayed rehabilitation. Good quality analgesia with minimum side effects is required for post-operative rehabilitation andinfluences overall outcome of patients.Material And Methods:All patients were given spinal anaesthesia. Intraoperatively, all patients received periarticular infiltration with solution of bupivacaine, adrenaline, dexmedetomidine and magnesium sulphate and normal saline. Post-operatively all patients received intravenous diclofenac sodium 75 mg 12 hourly. Postoperative pain using VAS score, sedation using Ramsay sedation score and hemodynamic parameters were observed.Result:The mean VAS score for pain was <2 during the first 48 hours and provided good analgesia to the patients. During the post-operative period hemodynamic parameters remained comparable to baseline and all patients were co-operative, oriented and tranquil. None of the patient developed any side effects.Conclusion:Local infiltration with bupivacaine, adrenaline, dexmedetomidine and magnesium sulphate can be used along with intravenous diclofenac sodium in patients undergoing total knee arthroplasty and is effective, safe and reliable multimodal pain regimen.

A comparative study of low dose magnesium sulphate therapy with Pritchard’s regime in management of Eclampsia

Background: Eclampsia is one of the most common causes of maternal and perinatal mortality and morbidity in India. Amongst the principles of management of eclampsia, the first is the control of convulsions. Magnesium sulphate is the main stay of treatment in eclampsia and imminent eclampsia. Average weight of Indian women is less than the western women due to which lower dose of magnesium sulphate can be used.  The aim of the study was to compare the efficacy of low dose magnesium sulphate regimen with standard Pritchard regimen in control of eclampsia.Methods: The study was carried out at emergency labour room, GMERS Sola Civil Hospital Ahmedabad. 120 patients of eclampsia were divided randomly into study group (n=60) receiving low dose MgSO4 and control group (n=60) receiving Pritchard regimen. The recurrence of convulsion, toxicity of MgSO4 and maternal and fetal outcome was studied.Results: It was observed that with low dose MgSO4 regime, convulsions were controlled in 91.7% of the cases. With standard Pritchard’s regime convulsions were controlled in 95% of patients. The maternal and perinatal mortality and morbidity were comparable in both groups.Conclusions: Low dose magnesium sulphate therapy is as effective as Pritchard’s regime for controlling convulsions in eclampsia and can be safely given in Indian women.

Maternal and perinatal outcome in eclampsia at a tertiary care center

Background: Preeclampsia is the occurrence of hypertension in combination with proteinuria, developing after 20 weeks gestation in a previously normotensive non-proteinuric patient. The objective of this study was to study the prevalance of eclampsia at PGIMS, Rohtak. To study the clinical profile, maternal and perinatal outcome in eclamptic patients.Methods: This is a retrospective study and case records of all eclampsia cases were analysed from the study period of January 2018 to December 2018.Results: There were 113 cases of eclampsia out of 11,661 deliveries and prevalence of eclampsia was calculated to be 0.96%. Majority of the patients were not registered 95.57%. 58% of patients were Primigravidas. 56% of the patient in the age group of 21-25 years. Antepartum, intrapartum and postpartum eclampsia were 71%, 1.7% and 27% respectively. Caesarean section was the preferred mode of delivery and was performed in 57% cases. ICU admission was required in 25% and remaining cases were managed in general/eclampsia ward. All patients received MgSO4 by Zuspan regimen. 12% patient developed HELLP syndrome and pulmonary oedema developed in 6% patient. There were a total of 3.5% maternal deaths during the study period. Total percentage of perinatal deaths due to eclampsia was 23%.Conclusions: Eclampsia continues to be one of the prime etiological factors for maternal and perinatal morbidity and mortality. This is due to lack of proper antenatal care, low socioeconomic condition and lack of education. Regular antenatal checkup, early recognition and proper management are vital to tackle this challenge. MgSo4 is the anticonvulsant of choice and Zuspan regimen of MgSO4 is effective in the management of eclampsia.

Prophylactic Use of Magnesium Sulphate to Prevent Arrythmias in Patients with Rheumatic Heart Disease Undergoing Closed Mitral Valvotomy

Maintenance of sinus rhythm is superior to incidence of atrial fibrillation (AF) in patients with rheumatic heartdisease undergoing Closed Mitral Valvotomy (CMV). The present study was done to evaluate the effect ofprophylactic use of Magnesium Sulphate (MgSo4), intravenously (i.v) soon after opening the stenosed MitralValve using Tubbs dilators by Surgeon, in patients undergoing CMV. One hundred and twenty patients withMitral Stenosis (MS) (mitral valve area < 1cm2), normal mitral valvular apparatus, no mitral regurgitation,mitral score not more than 7/16 planned for CMV. These patients were divided in two groups of 60 each.Group (I) (n=60) received. MgSo4, 30 mg/kg diluted to 20 ml with normal saline soon after mitral valvotomyand Group - II (n=60) received 20 ml of normal saline. The standardized protocol for CMV was maintainedfor all the patients. Before surgery AF was observed in 56.67% of patients in group I and 48.33% of patientsin group II (p=0.46). Postoperatively in ICU, 30% of patients in group I and 70% of patients in group II hadAF(p<0.0001). A single prophylactic intra operative dose of i.v MgSO4 decreased post valvotomy arrhythmiain comparision to placebo group . Thus, a single dose of intraoperative MgSO4 can be used to decreasepostoperative arrhythmias in patients of M.S undergoing CMV

Correlation of serum magnesium levels in eclampsia with pritchard and single dose magnesium sulphate regimen

Background: Magnesium sulphate is anticonvulsant of choice for eclampsia. Single dose magnesium sulphate therapy was tried for the management of Eclampsia and Imminent Eclampsia considering the low body mass index of Indian population.Methods: A prospective interventional study comprising of total 80 patients having either eclampsia or imminent eclampsia, to whom the Pritchard or a single dose MgSO4 was given alternatively in a tertiary hospital   from October 2014 to October 2017. Serum magnesium levels, maternal and perinatal outcome and recurrence of convulsions were evaluated using Student- t test and chi square test.Results: Mean Serum Magnesium levels in eclampsia and imminent eclampsia group at 0 min, 30 min, 4 hours in Pritchard regimen were 1.96mg/dl, 5.85mg/dl, 4.68mg/dl while in single dose regimen it was 1.78mg/dl, 462mg/dl, 3.63mg/dl respectively. Those who received Pritchard regimen showed higher level of Serum magnesium levels at 30 minutes and 4 hours than those receiving single dose. By applying T-test it was found that there is a significant difference in serum magnesium levels range in both group but no statistical difference in the control of convulsions in both groups.Conclusions: With increased and almost widespread use of magnesium sulfate in obstetrics there has been concerns regarding its safety. In the study, although P-values are not significant because of small sample size, there is considerable difference in serum magnesium levels 30 min and 4 hours, recurrence of convulsions and maternal morbidity between Pritchard regimen and single dose regimen. The goal which was achieved with Pritchard regimen previously, now can be achieved with single dose regimen in Indian women. Single dose magnesium sulphate is safe and effective in controlling convulsions with improved maternal and perinatal outcome.

A prospective study of the incidence and outcomes of eclampsia in a tertiary care hospital and teaching institute in India

Background: Eclampsia is a common cause of maternal and foetal morbidity and mortality in India and the rest of the world accounting for nearly 10% of all maternal deaths. However, there is a relative scarcity of outcome data for patients with eclampsia in India. Our goal was to estimate the incidence of eclampsia, the maternal and foetal outcomes of patients presenting with eclampsia, and predictors of clinical outcomes in these patients. Objective of this study was to estimate the incidence of eclampsia in patients who delivered at a single tertiary care institution over a 2-year period and to study the maternal and perinatal outcomes in those patients.Methods: Prospective cohort study conducted from September 2008 to August 2010 on all patients with eclampsia admitted during the study period at Lok Nayak Hospital, New Delhi, India.Results: The incidence of eclampsia among total deliveries was 0.45%.  About 97% of these patients received parenteral magnesium sulphate as the primary anticonvulsant therapy. Caesarean section was performed in 22.7% and majorities were done for foetal distress. Maternal complications were encountered among 17% of patients. There were 2 maternal deaths (2.3%), 13 stillbirths (14.1%) and 7 early neonatal deaths (7.9%).Conclusions: The incidence of eclampsia among all deliveries over a 2-year period at a tertiary care centre in India was 0.45%. Parenteral magnesium sulphate was effective in the vast majority of these patients in controlling the seizures. Further studies to evaluate whether early registration for antepartum care improves maternal and foetal outcomes in patients with eclampsia are warranted.

Evaluation of efficacy of intravenous magnesium sulphate versus dexamethasone for prevention of postoperative sore throat in patients undergoing lumbar spine surgery in prone position: a prospective randomized double blind placebo controlled study

Background: Endotracheal intubation is associated with postoperative sore throat. The aim was to evaluate the efficacy of intravenous magnesium sulphate versus dexamethasone for prevention of postoperative sore throat in patients undergoing lumbar surgery in prone position.Methods: 150 patients of ASA physical status I and II in the age group of 18 to 70 years were divided into three groups of 50 each. group I (magnesium sulphate) received intravenous magnesium sulphate 30 mg. kg-1 in a total of 50 ml of normal saline for 10 minutes after intubation, group II (dexamethasone group) received intravenous dexamethasone 8 mg in 50 mL normal saline for 10 minutes after intubation and group III (placebo group) received 50 ml of normal saline for 10 minutes after intubation. The incidence and severity of postoperative sore throat and hoarseness was assessed by an anesthesiologist unaware of the group allocation, on arrival in the post anesthesia care unit at 0 h, and at 1 h, 6 h, 12 h, and 24 h thereafter.Results: Both incidence and severity of sore throat and incidence of hoarseness was more in placebo group than magnesium sulphate group and dexamethasone group and was statistically significant (p<0.05) and was comparable between magnesium sulphate and dexamethasone groups.Conclusions: Endotracheal intubation is associated with sore throat and hoarseness of voice. Magnesium sulphate and dexamethasone given intravenously reduce the incidence and severity of sore throat and hoarseness associated with endotracheal intubation.

To Evaluate the Effectiveness of Magnesium Sulphate as an Agent to induce Hypotensive Anaesthesia in Lumbar Spine Surgery. A Prospective Randomized, Placebo-Control Study

Introduction: This randomized placebo controlled study wasdesigned to evaluate the effectiveness of magnesium sulphateas an agent to induce hypotensive anaesthesia in lumbar spinesurgery.Material and Methods: The study included 100 patients ofboth sexes who were equally distributed in two groups, theGroup Mg(Magnesium sulphate group) and Group C (controlgroup). The Magnesium group received magnesium sulphate40mg/kg administered as a slow IV bolus over a period of 10minutes before induction and 15mg/kg/hr by continuous IVinfusion during surgery. The same volume of isotonic salinewas administered to the control group. Surgical time, heartrate and mean arterial blood pressure was measured.Results: In the magnesium group there was reduction insurgical time (103.54 mins vs 117.34 mins), although theanaesthestic time was 9 minutes longer in the Magnesiumgroup denoting a longer emergence time. The mean arterialpressure and heart rate were significantly reduced inMagnesium group(p<0.005). Postoperative shivering was alsoless in Magnesium group.Conclusion: Magnesium infusion resulted in a steady andsmooth reduction in mean blood pressure and reduced heartrate, with no episodes of severe hypotension. Furthermoremagnesium causes reduction in duration of surgical time andpostoperative shivering

Role of low dose Magnesium sulphate in eclampsia

Background: Eclampsia is one of the challenging medical complications seen during pregnancy. With the use of magnesium sulphate for control of convulsion in eclampsia, it can be managed effectively.Methods: This is a prospective study done in a tertiary care hospital. Considering low body mass index of patients of developing area, authors had used low dose regime of magnesium sulphate. 100 patients had been enrolled for low dose magnesium sulphate regime after categorizing patients as per inclusion and exclusion criteria. The primary outcome to be measured was recurrence of fits in any patients who received low dose magnesium sulphate. The secondary outcome measured were development of any toxicity, level of serum magnesium level, maternal and perinatal outcome.Results: It was observed that 93% of the patients responded to low dose regime. 7% developed  recurrence of fits for that additional dose of 2 gram of 20% magnesium sulphate was given to the patients. Not even a single patient developed signs of toxicity. 94% and 95% of the patients acquired therapeutic level of serum magnesium at 4 hours and 10 hours of magnesium sulphate administration, respectively. Maternal mortality was 5% and perinatal mortality was 24.4%.Conclusions: Low dose of magnesium sulphate can prevent and treat eclampsia. Low dose regimen also reduces incidence of toxicity with improved maternal and perinatal outcome.

Efficacy of low dose magnesium sulphate regime and Pritchard’s regime in controlling of eclamptic convulsion and prevention of recurrence

Background: Eclampsia is defined as the onset of convulsions or coma during pregnancy or in post-partum period in a patient who has signs and symptoms of pre-eclampsia. It is life threatening emergency that continues to be a major cause of serious maternal morbidity and mortality also along with high perinatal mortality and morbidity. The present study undertaken to determine the efficacy of low dose magnesium sulphate regime and Pritchard’s regime in controlling eclamptic convulsion and prevention of recurrence of convulsion.Methods: Out of total 60 patients enrolled in the study; 30 were given low dose magnesium sulphate regime and remaining 30 with Pritchard’s regime. Selection of patients was done with simple random sampling. Relevant history was obtained from the patient, if conscious, or from the relatives. Through clinical examination was done and blood samples were collected for investigations after securing IV line.Results: There was insignificant difference regarding type of eclampsia in both groups. Recurrence of convulsion in Pritchard’s regime group was 6.67% and in Low dose regime group found to be 10% but this was statistically insignificant. Total dose of magnesium sulphate required in Low dose regime group was less than that required for Pritchard’s regime.Conclusions: Low dose magnesium sulphate Regime proved equally effective as that of Pritchard’s regime in control of convulsion in spite of less amount of drug and comparatively low serum magnesium levels and hence there is hardly any fear of intoxicator.

Effect of magnesium sulphate and milrinone on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a randomized study / Efeitos do sulfato de magnésio e da milrinona sobre o vasoespasmo cerebral após hemorragia subaracnoidea por aneurisma: estudo randômico

Abstract Background: Aneurysmal subarachnoid hemorrhage is an important cause of premature death and disability worldwide. Magnesium sulphate is shown to have a neuroprotective effect and it reverses cerebral vasospasm. Milrinone is also used in the treatment of cerebral vasospasm. The aim of the present study was to compare the effect of prophylactic magnesium sulphate and milrinone on the incidence of cerebral vasospasm after subarachnoid hemorrhage. Methods: The study included 90 patients with aneurysmal subarachnoid hemorrhage classified randomly (by simple randomization) into two groups: magnesium sulphate was given as an infusion of 500 mg.day-1 without loading dose for 21 days. Group B: milrinone was given as an infusion of 0.5 µg.kg-1.min-1 without loading dose for 21 days. The cerebral vasospasm was diagnosed by mean cerebral blood flow velocity in the involved cerebral artery (mean flow velocity ≥ 120 cm.s-1), neurological deterioration by Glasgow coma scale, or angiography (the decrease in diameter of the involved cerebral artery >25%). Results: The mean cerebral blood flow velocity decreased significantly in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p < 0.001). The incidence of cerebral vasospasm decreased significantly with magnesium compared to milrinone (p = 0.007). The Glasgow coma scale significantly improved in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p = 0.036, p = 0.012, p = 0.016, respectively). The incidence of hypotension was higher with milrinone than magnesium (p = 0.012). Conclusions: The incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage was significantly lower and Glasgow coma scale significantly better with magnesium when compared to milrinone. Milrinone was associated with a higher incidence of hypotension and requirement for dopamine and norepinephrine when compared to magnesium.

Resumo Justificativa: A hemorragia subaracnoidea por aneurisma é uma importante causa de morte prematura e de incapacidade em todo o mundo. O sulfato de magnésio mostra um efeito neuroprotetor e reverte o vasoespasmo cerebral. A milrinona também é usada no tratamento de vasoespasmo cerebral. O objetivo do presente estudo foi comparar o efeito profilático do sulfato de magnésio e da milrinona sobre a incidência de vasoespasmo cerebral após hemorragia subaracnoidea. Métodos: O estudo incluiu 90 pacientes com hemorragia subaracnoidea por aneurisma randomicamente distribuídos (randomização simples) em dois grupos: sulfato de magnésio foi administrado em infusão de 500 mg.dia-1 sem dose de ataque durante 21 dias. O Grupo B recebeu milrinona em infusão de 0,5 µg.kg-1·min-1 sem dose de ataque durante 21 dias. O vasoespasmo cerebral foi diagnosticado pela velocidade média do fluxo sanguíneo cerebral na artéria cerebral envolvida (velocidade média do fluxo ≥ 120 cm.s-1), a deterioração neurológica por escala de coma de Glasgow ou angiografia (diminuição do diâmetro da artéria cerebral envolvida > 25%). Resultados: A velocidade média do fluxo sanguíneo cerebral diminuiu significativamente no grupo magnésio em comparação com o grupo milrinona nos dias 7, 14 e 21 (p < 0,001). A incidência de vasoespasmo cerebral diminuiu significativamente com o magnésio em comparação com milrinona (p = 0,007). A escala de coma de Glasgow melhorou significativamente no grupo magnésio em comparação com o grupo milrinona nos dias 7, 14 e 21 (p = 0,036, p = 0,012, p = 0,016, respectivamente). A incidência de hipotensão foi maior com milrinona do que com magnésio (p = 0,012). Conclusões: A incidência de vasoespasmo cerebral após hemorragia subaracnoidea por aneurisma foi significativamente menor e a escala de coma de Glasgow significativamente melhor com magnésio em comparação com milrinona. A milrinona foi associada a uma maior incidência de hipotensão e necessidade de dopamina e norepinefrina em comparação com o magnésio.

A Comparative Study Of Effects Of Clonidine And Magnesium Sulphate On Propofol Requirement In Craniotomy Patients Under General Anaesthesia

Introduction :Awareness can be defined as the subjective experience of external or internal stimuli. Recent review of reported cases of awareness suggested the absence of volatile agents or intravenous agents during maintenance of anaesthesia 2. Material & Methods:The study was conducted in SMS Medical College and attached hospital, Jaipur after approval from the institutional ethics committee. The present study was conducted in 105 patients 35 in each group of ASA physical status 1 & 2 posted for elective spinal surgery under general anaesthesia, age between 20-50 years, Hospital – based, randomized, double blind, comparative interventional study. The sample size was calculated 35 subjects in each group. Results: In recovery period, the time to reach BIS to 80 was found to be significantly more in Group B compared to Group C and Group A [P<0.001]. When the groups were compared, all the three parameters of recovery (extubation time, response to verbal commands and time for orientation) were found to be significantly longer in Group B. There were no significant difference between the other two groups, i.e. Group Aand Group C (P< 0.001).Propofol Induction and Maintenance dose found to be significantly more in Group C as compared to group B than Group A. (P < 0.001). Total Propofol requirement was significantly more in group C as compared to group B than Group A. (P< 0.001). Conclusion: Perioperative use of both clonidine and magnesium sulphate significantly reduced the requirement of propofol. They were able to attenuate the haemodynamic response to tracheal intubation. Clonidine was associated with bradycardia and hypotension. Magnesium sulphate caused a delay in recovery.

A prospective randomised study comparing intravenous magnesium sulphate and sublingual nitroglycerine spray in attenuating haemodynamic responses to laryngoscopy and intubation

Background:Laryngoscopy and tracheal Intubation are invariably associated with certain stress responses due to the sympatho-adrenal stimulation. These cardiovascular and neurohumoral alterations may directly affect the physiology and increase the risk. So far, various drugs have been tried but none has been considered ideal for blunting this presser response. We therefore, planned this comparative study to evaluate and compare the efficacy of intravenous magnesium sulphate (30mg/kg) versus sublingual nitroglycerine spray (0.4mg/spray) in attenuating the presser response to Laryngoscopy and Tracheal Intubation.Methods:Fifty patients, aged 15–50 years, scheduled for elective surgery under general anaesthesia, were randomly assigned to one of the two groups of 25 each, Group A (magnesium group) and Group B(nitroglycerine group). Study drug was given 90-120 seconds before tracheal intubation. Heart rate, Systolic blood pressure and Rate pressure product were recordedat different intervals after administering the study drug till 3 minutes after intubation.Results:Mean heart rate was significantly higher from the baseline at all times after administering the study drug in both the groups. Increase in systolic blood pressure as a presser response was limited to 7.25% in Group A and 5.83% in Group B from the baseline after tracheal intubation. There was relative hypotension after administration of the study drug in both the groups. Conclusions: Intravenous magnesium or sublingual nitroglycerine pre-treatment is found to be effective in attenuating the presser response to laryngoscopy and intubation. These drugs may lead to rise in HR but it is transient and dose dependent. However, both the drugs can significantly control the hypertensive response after laryngoscopy and intubation.

A Comparative Study Of The Efficacy And Side Effects Of Isoxsuprine And Magnesium Sulphate In The Management Of Preterm Labour

Preterm labour, the most important single determinant of adverse infant outcome in terms of both survival and quality of life, is problematic because of the several neonatal complications and the long term sequelae. Preterm birth affects 12 – 18% of all births in India. Tocolytic therapy is the most commonly used strategy to arrest preterm labour. Isoxsuprine, a ß sympathomimetic agent is a drug that is currently used as a tocolytic but is associated with serious side effects. Magnesium sulphate is another Tocolytic which has also been the focus of recent research for its neuroprotective effects on preterm babies. We have compared the two in this study. Objectives: To compare the efficacy of Isoxsuprine with magnesium sulphate with respect to 1. Cessation of labour pains and prolongation of gestational age 2. Drug related side effects 3. The perinatal outcome Methodology : 50 patients who came to Jubilee Mission Medical College hospital with preterm labour from November 2012 to April 2014 were randomised into two groups of 25 each. Group I was given Isoxsuprine 90mg intravenously in 1000ml Ringer lactate solution at the rate of 0.05 – 0.20 mg/min. Group M was given magnesium sulphate, loading dose of 4gm diluted in 100ml normal saline intravenously, followed by a continuous infusion of 2gm/hr for at least 12 hours. The vitals, urine output and patellar reflex of the patients were monitored. Results: The mean number of days gained in utero in group I and group M were 30.88 ±21.24 and 27.26±18.79 days respectively. The percentage of NICU admissions in group I was 28% and group M was 28%. Maternal side effects were noted in 32% in group I and 20% in group M. Conclusion: Magnesium sulphate is comparable to Isoxsuprine in its efficacy in managing preterm labour with less maternal and neonatal side effect

A Comparative study on Adenosine and Magnesium Sulphate with Bupivacaine in Infraclavicular infusion for Postoperative Analgesia

Background: Brachial plexus piece has reformed the field of regional anaesthesia for upper limb surgeries. Infraclavicular subcoracoid approach gives complete block without significant difficulties. Aim: To compare the additives adenosine and magnesium sulphate with bupivacaine in infraclavicular infusion for upper limb surgeries and postoperative analgesia. Materials & Methods: This Prospective study was done at the Department of Anaesthesiology, Govt. Medical College, Azamgarh. Around 24 patients scheduled for elective unilateral upper limb surgeries involving distal arm/ elbow/ forearm/hand divided into two groups A (n-12) and B (n-12) randomly. Group A - adenosine 6mgs with 28 ml 0.5% bupivacaine bolus followed by infusion of 0.25% bupivacaine 28ml with 6mgs of adenosine (2ml) at a rate of 5ml/hr. Group B - magnesium sulphate 75 mgs (in 2ml) with 28ml of 0.5% bupivacaine bolus followed by infusion of 0.25% bupivacaine 28ml with 75mgs of magnesium sulphate (in 2ml) at a rate of 5ml/hr in USG guided placement of infraclavicular catheter. Results: Our Study revealed  that  Group  A  had a  faster Onset time of sensory and motor block and faster recovery when compared to group B. Group A needed more rescue analgesia than group B. Conclusion: The addition of magnesium sulphate as an additive to bupivacaine in brachial plexus block may be a better choice when prolonged postoperative analgesia is required.

Comparative study of epidural fentanyl and epidural fentanyl with magnesium sulphate for post-operative analgesia in patients undergoing lower limb surgeries

Background: Control of post-operative pain is a major concern for the patients and also for the treating physicians. Various analgesic agents such as opioids, nonopioids through various routes such as oral, intravenous, neuraxial, regional for the management of postoperative pain exist. Magnesium has anti-nociceptive properties with additional enhancement of opioid anti-nociception when used epidurally. Materials and methods: The study was a randomized open labelled controlled trail, conducted in the department of anaesthesiology, Govt. Mohan Kumaramangalam Medical College and Hospital, Salem, Tamil Nadu. The data collection for the study was done between June 2016 to June 2017. The study population included people who were undergoing lower limb surgery for various disease conditions. The key outcome variables assessed were highest sensory blockade, time taken for highest sensory level (min), duration of surgery (min), time for regression to L1 (min), duration of analgesia (min). Results: Duration of analgesia was longer in the Magnesium sulphate group, with analgesia lasting for 143.4 +39.57 minutes which was statistically significantly higher compared to Epidural Fentanyl group with 107 (±25.82) minutes. The mean time for regression to L1 was 118 minutes and 119 minutes in group F and FM respectively, there is no statistically significant between two study groups (P value>0.05). There was no statistically significant difference between the groups in the time taken J. Radhika, P. Kayalvizhi. Comparative study of epidural fentanyl and epidural fentanyl with magnesium sulphate for postoperative analgesia in patients undergoing lower limb surgeries. IAIM, 2018; 5(2): 12-19. Page 13 for the highest sensory level (P value>0.05), the duration of surgery and the time taken for the highest sensory level (P value>0.05). Conclusion: Magnesium being a relatively harmless and inexpensive molecule, a non-competitive, Nmethyl-D-aspartate receptor antagonist with its anti-nociceptive properties has a huge role to play in the coming years for postoperative analgesia

Role of magnesium sulphate in preterm labour

Introduction: Magnesium sulphate has been the drug of choice for the prophylaxis of convulsions in women with preeclampsia for many years. The use of this drug for the treatment of preterm labour originated in the observation that it causes a decrease in frequency and intensity of contractions in preeclampsia women in labour. The present study is conducted to study the effectiveness of intravenous magnesium sulphate in arrest of preterm labour. Materials and methods: The present study was conducted among 50 patients admitted in labor wards of obstetrics and gynecology department. Study was conducted at Gayatri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam. Study duration was from February 2016 to March 2017. Fifty patients with a diagnosis of preterm labor between 28 to 36 weeks period of gestation were included. A loading dose of intravenous magnesium sulfate 4 gm bolus over 20mins followed by 2g/hour infusion was administered until uterine quiescence was achieved. Results: The mean time taken for uterine quiescence was 74 mins after starting treatment. The magnesium sulfate dosage requirement for uterine quiescence was 1-2 gm/hour in 87.5% cases. Majority of the mothers experienced mild side effects but none were as serious as to discontinue the drug. Toxicity features were observed in 4% of cases, which need to discontinue the drug. Conclusion: Intravenous magnesium sulphate is effective in postponement of preterm labour at least for 48 hours. This is the minimum time considered sufficient to allow benefit if corticosteroids are administered to decrease the possibility of respiratory distress syndrome in premature infants. Thus magnesium sulphate plays a vital role in preterm labour

Comparison between Magnesium Sulphate and Esmolol in Attenuating Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation

@#During induction of general anaesthesia, the act of laryngoscopy and tracheal intubation stimulates the sympathetic nervous system resulting in an increase in blood pressure and heart rate which may be harmful especially in elderly patients with pre-existing ischaemic heart disease. Several drugs have therefore been used to obtund this increase including esmolol, nicardipine, magnesium sulphate and lignocaine. This prospective, double blind randomised clinical trial compared the efficacy of magnesium sulphate and esmolol in attenuating haemodynamic responses to laryngoscopy and tracheal intubation. One hundred and twenty six ASA I-II patients scheduled for elective surgery requiring general anaesthesia with tracheal intubation were enrolled and randomised into two groups: Group 1 (n = 67) received MgSO4 40 mg/kg diluted in 100 ml normal saline administered over ten minutes, whereas Group 2 (n = 59) received a bolus of esmolol 1.0 mg/kg diluted to 10 ml. Systolic and diastolic blood pressures and heart rate were recorded every minute for subsequent 10 minutes following laryngoscopy and tracheal intubation. Attenuation of the mean systolic and diastolic blood pressures following laryngoscopy and tracheal intubation was significantly larger in Group 2 compared to Group 1. Patients in Group 2 had significantly better suppression of heart rate response compared to Group 1 during the first four minutes after laryngoscopy and tracheal intubation (p<0.05). Attenuation of the haemodynamic response to laryngoscopy and tracheal intubation by esmolol 1.0 mg/kg was more pronounced compared to MgSO4 40 mg/kg in normotensive patients undergoing general anaesthesia for elective surgery.

Infiltración intraarticular con sulfato de magnesio y bupivacaína en fracturas de radio distal. Estudio piloto / Intrarticular infiltration of bupivacaine and magnesium sulfate in distal radius fractures. A pilot study

Resumen: Antecedentes: Las fracturas de radio distal constituyen hasta 15% de todas las lesiones óseas en los adultos. La rehabilitación es clave en la recuperación de la movilidad y la capacidad funcional. El sulfato de magnesio intraarticular ha sido utilizado para control postoperatorio del dolor; el objetivo fue determinar la mejoría del dolor y la capacidad funcional de los pacientes con fractura de radio distal usando sulfato de magnesio intraarticular. Material y métodos: Pacientes con fractura de radio distal tratados con clavos percutáneos e inmovilización fueron incluidos al azar en dos grupos. Grupo 1 infiltrado con 1.0 ml de sulfato de magnesio y 1.5 ml de agua estéril; en el grupo 2 esta última fue sustituida por 1 ml de bupivacaína (5 mg/ml). La infiltración se realizó al retiro de la inmovilización. El dolor, funcionalidad y rangos de movimiento fueron evaluados. Resultados: 20 pacientes, ocho masculinos y 12 femeninos con edad promedio de 53 años (± 17 DE) fueron evaluados. Se encontró disminución significativa en el dolor al primer minuto y a los tres minutos después de la infiltración en el grupo 2 (p < 0.05). Ambos grupos presentaron una mejoría significativa en la funcionalidad articular a las dos semanas (p < 0.05), así como una mejoría gradual en la movilidad articular en ese mismo período (p < 0.05). Conclusiones: La infiltración de sulfato de magnesio en combinación con bupivacaína ayuda a disminuir el dolor.

Abstract: Background: The distal radius fracture represent until 15% of all bone injuries in adults. The key in the recovery of mobility and functional outcomes are rehabilitation. The intra-articular application of magnesium sulphate has been used for postoperative pain. The objective was to determinate the improvement in pain and functional outcome of patients with distal radius fracture using intra-articular magnesium sulphate. Material and methods: Patients with distal radius fracture treated with percutaneous pinning and cast immobilization was included and randomized into two groups. The group 1 was applied 1.0 ml of magnesium sulphate and 1.5 ml of injectable water; meanwhile the group 2, the water was replaced with 1 ml of bupivacaine (5 mg/ml). The intra-articular infiltration was applied at the end of immobilization. Pain, functionality and movement of the wrist was evaluated for two weeks. Results: Twenty patients, 8 male and twelve females, with a mean age of 53 years (± 17 SD) was evaluated. A significative reduction of pain during the first minute and at three minutes after intra-articular infiltration in group 2 (p < 0.05). Both groups presented better articular outcomes at the two weeks (p < 0.05), and a better articular movement at same point (p < 0.05). Conclusions: The intra-articular infiltration of magnesium sulphate plus bupivacaine help to reduces the pain.