Effects of preoperative magnesium sulphate on post-cesarean pain, a placebo controlled double blind study.

  • Seyed Mohamad Mireskandari Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran.
  • Khalil Pestei Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran.
  • Asghar Hajipour Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran.
  • Afshin Jafarzadeh Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran.
  • Shahram Samadi Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran.
  • Omid Nabavian Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran.
Keywords: Cesarean, General anesthesia, Magnesium sulfate, Opioid, Pain

Abstract

To study the role of preoperative intravenous magnesium sulphate in decreasing post-cesarean pain and opioid requirement during first 24hrs.In a double blind randomized clinical trial, prior to induction of general anesthesia, fifty elective cesarean candidates were randomly assigned to one of the two groups of placebo or magnesium sulfate. After surgery visual analogue scale (VAS) and infused morphine by PCA during 24 hrs were recorded. The data were analyzed by mann-Whitney -test, analysis of variance, and student t- test.VAS was significantly lower among patients in the magnesium sulphate group at intervals of 1(st), 6(th) & 12(th) hours after cesarean section (C/S) with the mean scales of (48.9 ± 19.6 VS 74.7 ± 18.4), (42.1 ± 0.9 VS 58.3 ± 16.5) and (25.2 ± 6.1VS 30 ± 8.1) respectively and p-value of < 0.001, 0.002 and 0.05 respectively. However at 24 hrs there was no significant difference in VAS with mean VAS scales of 22.6 ± 4.5 VS 23.6 ± 4.9 and p-value of 0.49. The dose of infused Morphine during 24 hrs was significantly less in the magnesium sulphate group than the placebo group with the means of 4.36 ± 1.4 VS 7.02 ± 1.9 mg respectively (p < 0.001).Administration of bolus 50 mg/kg magnesium sulphate prior to induction of general anesthesia may significantly decreased the morphine requirement during immediate post operative period and can be recommended as one of the modalities of post-operative pain control in the pregnant patients.

References

Kissin I. Preemptive analgesia. Anesthesiology 2000; 93: 1138-43.

Berkman ND, Thorp JM, Lohr KN, Carey TS, Hartman KE,Gavin NI, et al. Tocolytic treatment for the management of preterm labor: a review of the evidence. Am J Obstet Gynecol 2003; 188: 1648-59.

Woolf CJ, Thomson SWN. The induction and maintenance of central sensitization is dependent on acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain 1991; 44: 293-9.

Ghazi-saidi K, Hajipour A. Effects of preemptive Ketamine on post-cesarean analgesic requirement. Acta Medica Iranica 2002; 40: 100-3.

Xiao WH, Bennett GJ. Magnesium suppresses neuropathic pain responses in rats via a spinal site of action. Brain Res 1994; 666: 168-72.

Tramer MR, Schneider J, Marti RA, Rifat K. Role of magnesium sulfate in postoperative analgesia. Anesthesiology 1996; 84: 340-7.

Altman D, Carroli G, Dudley L, Farrell B, Moodley J, Neilson J, et al. Do women with pre-eclampsia and their babies benefit from magnesium sulphate? The Magpie trial: a randomized placebo controlled trial. Lancet 2002; 359: 1877-90.

Iseri LT, French JH. Magnesium: nature’s physiologic calcium blocker. Am Heart J 1984; 108: 188-93.

Mayer ML, Westbrook GL, Guthrie PB. Voltagedependent block by Mg2+ of NMDA responses in spinal cord neurons. ature1984; 309: 261-3.

Albrecht E, Kirkham KR, Liu SS, Brull R. Perioperative intravenous administration of magnesium sulphate and postoperative pain: a meta-analysis. Anaesthesia 2013; 68: 79-90.

Albrecht E, Kirkham KR, Liu SS, Brull R. The analgesic efficacy and safety of neuraxial magnesium sulphate: a quantitative review. Anaesthesia 2013; 68: 190-202.

Lee DH, Kwon IC. Magnesium sulphate has beneficial effects as an adjuvant duringgeneral anaesthesia for Caesarean section.Br JAnaesth 2009; 103: 861-6.

Ryu JH, Kang MH, Park KS, Do SH. Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia. Br JAnaesth 2008; 100: 397-403.

Ko SH, Lim H-R, Kim D-C, Han Y-J, Choe H, Song HS. Magnesium sulfate does not reduce postoperative analgesicrequirements. Anesthesiology 2001; 95: 640-6.

Paech Michael J, Magann Everett F, Doherty Dorota A, Verity Lisa J, Newnham John P. Does magnesium sulfate reduce the short- and long-termrequirements for pain relief after caesarean delivery? A double-blind placebo-controlled trial. American Journal of Obstetrics and Gynecology 2006: 194: 1596-603.

Kiran S, Gupta R, Verma D. Evaluation of a singledose ofintravenous magnesium sulphate for prevention of postoperativepain after inguinal surgery. Indian Journal of Anaesthesia 2011; 55: 31-5.

James MFM. Magnesium: an emerging drug in anaesthesia. Br JAnaesth 2009; 103: 465-7.

Jee D, Lee D, Yun S, Lee C. Magnesium sulphate attenuates arterial pressure increase during laparoscopic cholecystectomy under pneumoperitoneum. Br J Anaesth 2009; 103: 484-9.

Ryu JH, Sohn IS, Do SH. Controlled hypotension for middle ear surgery: a comparison between remifentanil and magnesium sulphate.Br J Anaesth 2009; 103: 490-5. 20.Dube L, Granry JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anaesth 2003; 50: 732-46.

Kussman B1, Shorten G, Uppington J, Comunale ME. Administration of magnesium sulfate before rocurinium: effects on speed of onset and duration of neuromuscular block. Br J Anaesth 1997; 79: 122-4.

Fuchs-buder T, Wilder-smith OH, Borgeat A, Tassonyi E. Interaction of magnesium sulphate with vecuroniuminduced neuromuscular block. Br J Anaesth 1995; 74: 405-9.

How to Cite
1.
Mireskandari SM, Pestei K, Hajipour A, Jafarzadeh A, Samadi S, Nabavian O. Effects of preoperative magnesium sulphate on post-cesarean pain, a placebo controlled double blind study. J Fam Reprod Health. 9(1):29-33.
Section
Original Articles