Clinical Comparative Study Comparing Efficacy of Intrathecal Fentanyl and Magnesium as an Adjuvant to Hyperbaric Bupivacaine in Mild Pre-Eclamptic Patients Undergoing Caesarean Section
Adequate analgesia following caesarean section
decreases morbidity, hastens ambulation, improves patient outcome
and facilitates care of the newborn. Intrathecal magnesium, an
NMDA antagonist, has been shown to prolong analgesia without
significant side effects in healthy parturients. The aim of this study
was to evaluate the onset and duration of sensory and motor block,
hemodynamic effect, postoperative analgesia, and adverse effects of
magnesium or fentanyl given intrathecally with hyperbaric 0.5%
bupivacaine in patients with mild preeclampsia undergoing caesarean
section. Sixty women with mild preeclampsia undergoing elective
caesarean section were included in a prospective, double blind,
controlled trial. Patients were randomly assigned to receive spinal
anesthesia with 2 mL 0.5% hyperbaric bupivacaine with 12.5 μg
fentanyl (group F) or 0.1 ml of 50% magnesium sulphate (50 mg)
(group M) with 0.15ml preservative free distilled water. Onset,
duration and recovery of sensory and motor block, time to maximum
sensory block, duration of spinal anaesthesia and postoperative
analgesic requirements were studied. Statistical comparison was
carried out using the Chi-square or Fisher’s exact tests and
Independent Student’s t-test where appropriate. The onset of both
sensory and motor block was slower in the magnesium group. The
duration of spinal anaesthesia (246 vs. 284) and motor block (186.3
vs. 210) were significantly longer in the magnesium group. Total
analgesic top up requirement was less in group M. Hemodynamic
parameters were similar in both the groups. Intrathecal magnesium
caused minimal side effects. Since Fentanyl and other opioid
congeners are not available throughout the country easily,
magnesium with its easy availability and less side effect profile can
be a cost effective alternative to fentanyl in managing pregnancy
induced hypertension (PIH) patients given along with Bupivacaine
intrathecally in caesarean section.
[1] Wallace DH, Leveno KJ, Cunningham FG, et al. Randomized
comparison of general and regional anesthesia for cesarean delivery in
pregnancies complicated by severe pre-eclampsia. Obstet Gynecol 1995;
86:193–9.
[2] Karinen J, Rasanen J, Alahuhta S,et al. Maternal and uteroplacental
haemodynamic state in pre-eclamptic patients during spinal anaesthesia
for caesarean section. Br J Anaesth 1996; 76:616–20.
[3] Hood, David D. MD; Curry, Regina RN. Spinal versus epidural
anesthesia for cesarean section in severely pre-eclamptic patients: A
retrospective study. Anesthesiology 1999; 90:1276–12s82.
[4] Roseag OP, LuiACP, Cicutti NJ, et al. Perioperative multimodal pain
therapy for caesarean section: analgesia and fitness for discharge. Can J
Anesth 1997; 44:803–9.
[5] Schobel HP, Fischer T, Heuszer K, et al. Preeclampsia: a state of
sympathetic overactivity. N Engl J Med 1996; 335:1480–5.
[6] Kroin JS, McCarthy RJ, Von Roenn N, et al. Magnesium sulphate
potentiates morphine antinociception at the spinal level. Anesth Analg
2000; 90:913–7.
[7] Buvanendran A, McCarthy RJ, Kroin JS, et al. Intrathecal magnesium
prolongs fentanyl analgesia: a prospective, randomized, controlled trial.
Anesth Analg 2002; 95:661–6.
[8] Shoebi G, Sadegi M, Firazian A, Tabassomi F. The additional effect of
magnesium to lidocaine in spinal anaesthesia for caesarean section. Int J
Pharmacol 2007; 3:425-7.
[9] Ozalevli M, Cetin TO, Unlugence H, et al. The effect of adding
intrathecal magnesium sulphate to bupivacaine fentanyl spinal
anaesthesia. Acta Anaesthesiol Scand 2005; 49:1514–9.
[10] Mageed Nabil A, El-Ghoniemy Yasser F. Intrathecal fentanylmagnesium
for fast-track cardiac anaesthesia. Eg J Anaesth 2005;
21:289–93.
[11] Arcioni R, Palmisoni S, Tigano S et al. 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; 51:482–9.
[12] Marzouk S, El-Hady NA, Lotfy M, Darwish HM. The effect of three
different doses of intrathecal magnesium sulphate on spinal opioid
analgesia. Eg J Anaesth 2003; 19:405-9.
[13] Report of the National High Blood Pressure Education Program
Working Group on High Blood Pressure in Pregnancy. Am J Obstet
Gynecol. Jul 2000; 1831:S1-22.
[14] American College of Obstetricians and Gynecologists: Hypertension in
pregnancy. ACOG Technical Bulletin No. 219. Washington DC: 199
[15] Liu HT, Hollman MW, Liu WH et al. Modulation of NMDA receptor
function by ketamine and magnesium. Part 2. Anesth Analg 2001;
92:1173–81.
[16] Woolf CJ, Chong MS. Preemptive analgesia-treating postoperative pain
by preventing the establishment of central sensitization. Anesth Analg
1993; 77(2):362-79.
[17] 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
hypersensitivity states. Pain 1991; 44:293–9.
[18] Ko SH, Lim HR, Kim DC, et al. Magnesium sulfate does not reduce
postoperative analgesic requirements. Anesthesiology 2001; 95:640–6.
[19] S. Malleeswaran, N. Panda, P. Mathew, R. Bagga. A randomized study
of magnesium sulphateas an adjuvant to intrathecal bupivacaine in patients with mild pre-eclampsia undergoing caesarean section.
International Journal of Obstetric Anesthesia (2010) 19, 161-166.
[20] Jeffrey MichaelSmith, Richard F Lowe, Judith Fullerton, et al. An
Integrative Review of the Side Effects Related to the Use of Magnesium
Sulfate for Pre-eclampsia and Eclampsia Management. BMC Pregnancy
Childbirth. 2013;13(34)
[21] Witlin AG, Sibai BM. Magnesium sulfate therapy in preeclampsia and
eclampsia. ObstetGynecol1998; 92:883-9.
[22] Simpson JI, Eide TR, Schiff GA et al. Intrathecal magnesium sulphate
protects the spinal cord from ischaemic injury during thoracic aorta cross
clamping. Anesthesiology 1994; 81: 1493–9.
[23] Takano Y, Sato E, Kaneko T, Sato I. Antihyperalgesic effects of
intrathecally administered magnesium sulphate in rats. Pain 2000;
84:175–9.
[1] Wallace DH, Leveno KJ, Cunningham FG, et al. Randomized
comparison of general and regional anesthesia for cesarean delivery in
pregnancies complicated by severe pre-eclampsia. Obstet Gynecol 1995;
86:193–9.
[2] Karinen J, Rasanen J, Alahuhta S,et al. Maternal and uteroplacental
haemodynamic state in pre-eclamptic patients during spinal anaesthesia
for caesarean section. Br J Anaesth 1996; 76:616–20.
[3] Hood, David D. MD; Curry, Regina RN. Spinal versus epidural
anesthesia for cesarean section in severely pre-eclamptic patients: A
retrospective study. Anesthesiology 1999; 90:1276–12s82.
[4] Roseag OP, LuiACP, Cicutti NJ, et al. Perioperative multimodal pain
therapy for caesarean section: analgesia and fitness for discharge. Can J
Anesth 1997; 44:803–9.
[5] Schobel HP, Fischer T, Heuszer K, et al. Preeclampsia: a state of
sympathetic overactivity. N Engl J Med 1996; 335:1480–5.
[6] Kroin JS, McCarthy RJ, Von Roenn N, et al. Magnesium sulphate
potentiates morphine antinociception at the spinal level. Anesth Analg
2000; 90:913–7.
[7] Buvanendran A, McCarthy RJ, Kroin JS, et al. Intrathecal magnesium
prolongs fentanyl analgesia: a prospective, randomized, controlled trial.
Anesth Analg 2002; 95:661–6.
[8] Shoebi G, Sadegi M, Firazian A, Tabassomi F. The additional effect of
magnesium to lidocaine in spinal anaesthesia for caesarean section. Int J
Pharmacol 2007; 3:425-7.
[9] Ozalevli M, Cetin TO, Unlugence H, et al. The effect of adding
intrathecal magnesium sulphate to bupivacaine fentanyl spinal
anaesthesia. Acta Anaesthesiol Scand 2005; 49:1514–9.
[10] Mageed Nabil A, El-Ghoniemy Yasser F. Intrathecal fentanylmagnesium
for fast-track cardiac anaesthesia. Eg J Anaesth 2005;
21:289–93.
[11] Arcioni R, Palmisoni S, Tigano S et al. 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; 51:482–9.
[12] Marzouk S, El-Hady NA, Lotfy M, Darwish HM. The effect of three
different doses of intrathecal magnesium sulphate on spinal opioid
analgesia. Eg J Anaesth 2003; 19:405-9.
[13] Report of the National High Blood Pressure Education Program
Working Group on High Blood Pressure in Pregnancy. Am J Obstet
Gynecol. Jul 2000; 1831:S1-22.
[14] American College of Obstetricians and Gynecologists: Hypertension in
pregnancy. ACOG Technical Bulletin No. 219. Washington DC: 199
[15] Liu HT, Hollman MW, Liu WH et al. Modulation of NMDA receptor
function by ketamine and magnesium. Part 2. Anesth Analg 2001;
92:1173–81.
[16] Woolf CJ, Chong MS. Preemptive analgesia-treating postoperative pain
by preventing the establishment of central sensitization. Anesth Analg
1993; 77(2):362-79.
[17] 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
hypersensitivity states. Pain 1991; 44:293–9.
[18] Ko SH, Lim HR, Kim DC, et al. Magnesium sulfate does not reduce
postoperative analgesic requirements. Anesthesiology 2001; 95:640–6.
[19] S. Malleeswaran, N. Panda, P. Mathew, R. Bagga. A randomized study
of magnesium sulphateas an adjuvant to intrathecal bupivacaine in patients with mild pre-eclampsia undergoing caesarean section.
International Journal of Obstetric Anesthesia (2010) 19, 161-166.
[20] Jeffrey MichaelSmith, Richard F Lowe, Judith Fullerton, et al. An
Integrative Review of the Side Effects Related to the Use of Magnesium
Sulfate for Pre-eclampsia and Eclampsia Management. BMC Pregnancy
Childbirth. 2013;13(34)
[21] Witlin AG, Sibai BM. Magnesium sulfate therapy in preeclampsia and
eclampsia. ObstetGynecol1998; 92:883-9.
[22] Simpson JI, Eide TR, Schiff GA et al. Intrathecal magnesium sulphate
protects the spinal cord from ischaemic injury during thoracic aorta cross
clamping. Anesthesiology 1994; 81: 1493–9.
[23] Takano Y, Sato E, Kaneko T, Sato I. Antihyperalgesic effects of
intrathecally administered magnesium sulphate in rats. Pain 2000;
84:175–9.
@article{"International Journal of Medical, Medicine and Health Sciences:70828", author = "Sanchita B. Sarma and M. P. Nath", title = "Clinical Comparative Study Comparing Efficacy of Intrathecal Fentanyl and Magnesium as an Adjuvant to Hyperbaric Bupivacaine in Mild Pre-Eclamptic Patients Undergoing Caesarean Section", abstract = "Adequate analgesia following caesarean section
decreases morbidity, hastens ambulation, improves patient outcome
and facilitates care of the newborn. Intrathecal magnesium, an
NMDA antagonist, has been shown to prolong analgesia without
significant side effects in healthy parturients. The aim of this study
was to evaluate the onset and duration of sensory and motor block,
hemodynamic effect, postoperative analgesia, and adverse effects of
magnesium or fentanyl given intrathecally with hyperbaric 0.5%
bupivacaine in patients with mild preeclampsia undergoing caesarean
section. Sixty women with mild preeclampsia undergoing elective
caesarean section were included in a prospective, double blind,
controlled trial. Patients were randomly assigned to receive spinal
anesthesia with 2 mL 0.5% hyperbaric bupivacaine with 12.5 μg
fentanyl (group F) or 0.1 ml of 50% magnesium sulphate (50 mg)
(group M) with 0.15ml preservative free distilled water. Onset,
duration and recovery of sensory and motor block, time to maximum
sensory block, duration of spinal anaesthesia and postoperative
analgesic requirements were studied. Statistical comparison was
carried out using the Chi-square or Fisher’s exact tests and
Independent Student’s t-test where appropriate. The onset of both
sensory and motor block was slower in the magnesium group. The
duration of spinal anaesthesia (246 vs. 284) and motor block (186.3
vs. 210) were significantly longer in the magnesium group. Total
analgesic top up requirement was less in group M. Hemodynamic
parameters were similar in both the groups. Intrathecal magnesium
caused minimal side effects. Since Fentanyl and other opioid
congeners are not available throughout the country easily,
magnesium with its easy availability and less side effect profile can
be a cost effective alternative to fentanyl in managing pregnancy
induced hypertension (PIH) patients given along with Bupivacaine
intrathecally in caesarean section.", keywords = "Analgesia, magnesium, preeclampsia, spinal
anaesthesia.", volume = "9", number = "9", pages = "694-5", }