Publication: Comparison of the efficacy and safety of magnesium sulphate added ropivacaine 0.375% solution and ropivacaine 0.375% alone for pectoralis and serratus anterior nerve block in unilateral breast surgery
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Date
2021
Authors
Pin, Kang Wei
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Title: Comparison of the efficacy and safety of ropivacaine 0.375% with magnesium sulphate added and ropivacaine 0.375% alone in pectoralis and serratus anterior (PEC II) nerve block in unilateral breast surgery: A randomised controlled trial Introduction: PECS II nerve block is a multimodal analgesia approach for opioid sparing analgesia. Previous study had shown that addition of magnesium sulphate improved analgesic effect, reduced in opiod consumption with minimal side effect. This is the first study to evaluate its efficacy and safety of magnesium sulphate added into ropivacaine 0.375% as an adjuvant in PEC II block. Objective: To assess the efficacy analgesia and safety of magnesium sulphate added into ropivacaine 0.375% in PEC II nerve block in unilateral breast surgery. Methods: This was a double blinded randomised controlled trial. A total of 50 ASA class 1 and 2 patients who underwent a unilateral breast surgery with or without axillary clearance were randomised into 2 groups, intervention (M) group (n=25) who received ropivacaine 0.375% added with magnesium sulphate (5mmol) and control (R) group (n=25) who received ropivacaine 0.375% alone for PEC II nerve block. PEC II nerve block was performed under ultrasound guidance in sterile technique. Post-operative VAS pain score at 0, 4, 8, 12, and 24 hours were assessed. Intra and post-operative opioid rescue requirement usage were evaluated and documented. Post-operative side effect of magnesium sulphate such as nausea, vomiting, hypotension, cardiac arrhytmias and muscle weakness were assessed. Results: There was no statistical significants in demographic profile between groups. There was statistical significance difference in post-operative VAS mean pain score at rest from time 8hours and movement from time 4hours onwards (0.20 and 0.68, P-value of < 0.01). There was a significant difference in frequency of intra-operative opioid rescue requirement. (68% versus 7%, P-value < 0.05). There was no significant side effects or complications from the used of magnesium sulphate in this study. Conclusion: Pectoralis and serratus anterior (PEC II) nerve block with ropivacaine 0.375% and magnesium sulphate significantly reduced post-operative pain score and intra-operative opioid consumption without any significant side effects.
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