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A randomised study of magnesium sulphate as an adjuvant to intrathecal bupivacaine in patients with mild preeclampsia undergoing caesarean section - 14/4/2010

Int J Obstet Anesth 2010; 19: 161-6


Intrathecal magnesium, an NMDA antagonist, prolongs analgesia without significant side effects in healthy parturients. These authors studied the effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia in patients with mild pre-eclampsia undergoing Caesarean section.


This prospective, double-blind, placebo-controlled trial recruited 60 women with mild pre-eclampsia undergoing Caesarean section. Patients were randomly assigned to receive spinal anaesthesia with 2 ml 0.5% hyperbaric bupivacaine and 25 µg fentanyl with either 0.1 ml 0.9% sodium chloride (control group) or 0.1 ml 50% magnesium sulphate (50 mg) (magnesium group). The onset, duration and recovery of sensory and motor block, time to maximum sensory block, duration of spinal anaesthesia and postoperative analgesia requirements were studied.


The onset of both sensory and motor block was found to be slower in the magnesium group. The duration of spinal anaesthesia (229.3 versus 187.7 minutes) and motor block (200 versus 175.3 minutes) were significantly longer in the magnesium group. Diclofenac requirement for 24 hours following surgery was significantly lower in the magnesium group (147.5 versus182.5 mg; p=0.02). Haemodynamic parameters and side effect profile were similar in the two groups.


The authors conclude that, in parturients with mild pre-eclampsia undergoing Caesarean delivery, the addition of magnesium sulphate 50 mg to the intrathecal combination of bupivacaine and fentanyl prolongs the duration of analgesia and reduces postoperative analgesic requirements without additional side effects.

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