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The effect of adding intrathecal magnesium sulphate to morphine-fentanyl spinal analgesia after thoracic surgery. A prospective, double-blind, placebo-controlled research study.

Author(s): Ouerghi S, Fnaeich F, Frikha N, Mestiri T, Merghli A, Mebazaa MS, Kilani T, Ben Ammar MS

Affiliation(s): Department of Thoracic Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia.

Publication date & source: 2011-01, Ann Fr Anesth Reanim., 30(1):25-30. Epub 2010 Dec 8.

Publication type: Randomized Controlled Trial

BACKGROUND: We investigated whether intrathecally magnesium sulphate added to morphine and fentanyl reduces patients' postoperative analgesia requirements and prolongs spinal opioid analgesia after thoracotomy. METHODS: In a single-center, prospective, placebo-controlled, double-blind trial, we enrolled 58 adult patients undergoing elective posterolateral thoracotomy. Patients were randomized to receive either 25 mug of fentanyl citrate (0.5 mL)+300 mug of morphine+1.0 mL of preservative-free 0.9% sodium chloride (Group S) or 25 mug of fentanyl citrate (0.5 mL)+300 mug of morphine+50mg of magnesium sulphate 5% (1.0 mL) (Group MgSO(4)) for intrathecal analgesia. Opioid consumption and postoperative pain were assessed for 36 hours. RESULTS: VAS pain scores at rest and on coughing were similar in all groups. The total 36-h intravenous morphine requirements were significantly lower in group MgSO(4) (14 [9.50-26.50] mg vs. 33 [30-41] mg, p<0.001); i.e. 57% less for the group MgSO(4). The total dose of intravenous morphine administered during titration was significantly lower in this group (4 [2-8] mg vs. 8 [6-10] mg, p=0.001). Morphine consumption was significantly lower in the group MgSO(4) at intervals 0-12, 12-24 and 24-36 h. The number of patients requiring titration was significantly lower in group MgSO(4) (68% vs. 96%, p=0.001). There is no difference in opioid side effects. No patient experienced side effects resulting from lumbar puncture, or neurological deficit or signs of systemic magnesium toxicity. CONCLUSION: We found that in patients undergoing pulmonary resection with elective posterolateral thoracotomy, magnesium sulphate (50mg), when added to spinal morphine analgesia reduces postoperative morphine requirements, the number of patients requiring morphine titration without increasing opioid side effects. Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.

Page last updated: 2011-12-09

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