Intrathecal injection of magnesium sulfate: shivering prevention during cesarean section: a randomized, double-blinded, controlled study

다국어 초록 (Multilingual Abstract)

Background: Regional anesthesia is known to significantly impair thermoregulation and predispose patients to hypothermia. We hypothesized that the addition of an intrathecal injection of magnesium sulfate (MgSO4) to bupivacaine would improve perioperative shivering in female patients undergoing elective caesarean section.
Methods: In a block-randomized, double-blinded, controlled trial 72 patients scheduled for elective caesarean section with spinal anesthesia were separated into two groups. In the treatment group, 2 ml of 0.5% bupivacaine plus 25 mg MgSO4 (0.5 ml) were injected intrathecally, and in the control group 2 ml of 0.5% bupivacaine plus 0.5 ml normal saline were injected intrathecally. Core temperature was measured before and after drug injection at predetermined intervals. Sedation was graded using the Ramsay sedation scale.
Results: No significant intergroup differences in appearance of shivering were seen immediately or at 5, 30, 40, 50, 60, and 90 min after block administration. However, at 10, 15, and 20 min post block, there was a significant difference in shivering. The group administered MgSO4 showed lower shivering grades compared with the control group. Core temperature was significantly reduced in the MgSO4 group compared to the normal saline group 30 min after blocking.
Conclusions: Intrathecal injection of MgSO4 improved perioperative shivering in female patients undergoing elective caesarean section.

참고문헌 (Reference)

1 Mayer ML, "Voltage-dependent block by Mg2+ of NMDA responses in spinal cord neurones" 309 : 261-263, 1984

2 Sirvinskas E, "Use of magnesium sulphate in anesthesiology" 38 : 695-698, 2002

3 Kurz A, "Thermoregulatory response thresholds during spinal anaesthesia" 77 : 721-726, 1993

4 Sutherland J, "The influence of epidural pethidine on shivering during lower segment caesarean section under epidural anaesthesia" 19 : 228-232, 1991

5 Liu WH, "The effect of prophylactic fentanyl on shivering in elective caesarean section under epidural analgesia" 46 : 344-348, 1991

6 Vanderstappen I, "The effect of prophylactic clonidine on postoperative shivering. A large prospective double-blind study" 51 : 351-355, 1996

7 Yousef AA, "The effect of adding magnesium sulphate to epidural bupivacaine and fentanyl in elective caesarean section using combined spinal-epidural anaesthesia: a prospective double blind randomised study" 19 : 401-404, 2010

8 Ozalevli M, "The effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia" 49 : 1514-1519, 2005

9 Haubold HA, "Spinal anesthesia by Magnesium Sulphate.A report of seven operations performed under its influence" XLVI : 647-650, 1906

10 De Witte J, "Perioperative shivering: physiology and pharmacology" 96 : 467-484, 2002

11 Wadhwa A, "Magnesium sulphate only slightly reduces the shivering threshold in humans" 94 : 756-762, 2005

12 Kizilirmak S, "Magnesium sulfate stops postanesthetic shivering" 813 : 799-806, 1997

13 Gozdemir M, "Magnesium sulfate infusion prevents shivering during transurethral prostatectomy with spinal anesthesia: a randomized, double-blinded, controlled study" 22 : 184-189, 2010

14 McIntosh TK, "Magnesium protects against neurological deficit after brain injury" 482 : 252-260, 1989

15 Nowak L, "Magnesium gates glutamate-activated channels in mouse central neurones" 307 : 462-465, 1984

16 Rondón LJ, "Magnesium attenuates chronic hypersensitivity and spinal cord NMDA receptor phosphorylation in a rat model of diabetic neuropathic pain" 588 : 4205-4215, 2010

17 Lee AR, "Magnesium added to bupivacaine prolongs the duration of analgesia after interscalene nerve block" 59 : 21-27, 2012

18 Mebazaa MS, "Is magnesium sulfate by the intrathecal route efficient and safe?" 30 : 47-50, 2011

19 Chen JC, "Intrathecal meperidine attenuates shivering induced by spinal anesthesia" 31 : 19-24, 1993

20 Lejuste MJ, "Inadvertent intrathecal administration of magnesium sulfate" 68 : 367-368, 1985

21 Khalili G, "Effects of adjunct intrathecal magnesium sulfate to bupivacaine for spinal anesthesia: a randomized, double-blind trial in patients undergoing lower extremity surgery" 25 : 892-897, 2011

22 Gupta SD, "Effect of magnesium infusion on thoracic epidural analgesia" 5 : 55-61, 2011

23 Ramsay MA, "Controlled sedation with alphaxolone-alphadalone" 2 : 656-659, 1974

24 Ayatollahi V, "Comparison of prophylactic use of meperidine and two low doses of ketamine for prevention of post-anesthetic shivering: A randomized double-blind placebo controlled trial" 16 : 1340-1346, 2011

25 Khezri MB, "Comparison of postoperative analgesic effect of intrathecal magnesium and fentanyl added to bupivacaine in patients undergoing lower limb orthopedic surgery" 50 : 19-24, 2012

26 Buggy D, "Clonidine at induction reduces shivering after general anaesthesia" 44 : 263-267, 1997

27 Faiz SH, "Anesthetic effects of adding intrathecal neostigmine or magnesium sulphate to bupivacaine in patients under lower extremities surgeries" 17 : 918-922, 2012

28 Malleeswaran S, "A randomised study of magnesium sulphate as an adjuvant to intrathecal bupivacaine in patients with mild preeclampsia undergoing caesarean section" 19 : 161-166, 2010

29 Miyakawa H, "A comparison of three drugs (pethidine, magnesium sulfate and droperidol) in patients with post-anesthesia shivering" 40 : 1503-1506, 1991