Published: 2019-08-27

An evaluation of hyperbaric ropivacaine with magnesium as an adjuvant in lower abdominal surgeries among the north Indian subjects: a double-blind randomized trial

Sulekha Saxena, Kuljit Kumar, Rajni Gupta, Avinash Agrawal


Background: An evaluation of intrathecal hyperbaric ropivacaine without adjuvant and with adjuvant magnesium for lower abdominal surgeries.

Methods: This was a prospective, randomized, double-blind study conducted among the patients aged 18 to 60 years planned for lower abdomen surgeries under spinal anaesthesia and ASA grade I or II. Patients were randomly allocated to two groups (30 in each): ropivacaine Group (R group): spinal anesthesia with 3ml of 0.6% hyperbaric ropivacaine (18mg )+ 0.5ml NS. hyperbaric ropivacaine + Magnesium Group (R+M group ):   spinal anesthesia with 3ml of 0.6% hyperbaric ropivacaine (18mg) + 0.5ml magnesium sulphate (50 mg).  All the patients scheduled for operation were given oral tablets ranitidine 150 mg and Alprazolam 0.25mg in the night before surgery.

Results: There was no significant difference in the basic characteristics between the groups. The mean HR, MAP and SpO2 in both the groups decreased over the periods as compared to baseline. However, the trend of HR over the periods remains similar in both R and R+M groups. The bromage levels were significantly (p=0.0001) higher among the patients of Group R compared with R+M.  The 2 segment sensory regression (min), Sensory regression S2 (hr), motor recovery (hrs) and long term mobilization after spinal anesthesia were significantly (p=0.0001) lower among the patients of Group R compared with R+M. The complications were lower in Group R+M than R.

Conclusions: Magnesium may be more suitable drug in surgeries in which muscle relaxation has greater value in lower abdominal surgeries.


Abdominal surgeries, Hyperbaric ropivacaine, Magnesium, Spinal anesthesia

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O'Connor PJ, Hanson J, Finucane BT. Induced hypotension with epidural/general anaesthesia reduces transfusion in radical prostate surgery. Can Jou Anaesth. 2006;53:873-80.

Malhotra V, Sudheendra V, O’Hara J, Diwan J. Anesthesia and the Renal and Genitourinary Systems. In Miller RD, Ed. Miller's Anesthesia. New York: Churchill-Livingstone; 2010:105.

Chen TY, Tseng CC, Wang LK, Tsai TY, Chen BS, Chang CL. The Clinical Use of Small-Dose Tetracaine Spinal Anesthesia for Transurethral Prostatectomy. Anesth Analg. 2001;92:1020-3.

Brockway MS, Bannister J, McClure JH, McKeown D, Wildsmith JA. Comparison of extradural ropivacaine and bupivacaine. Br J Anaesth. 1991;66(1):31-7.

Fettes PD, Hocking G, Peterson MK, Luck JF, Wildsmith JA. Comparison of plain and hyperbaric solutions of ropivacaine for spinal anaesthesia. Br J Anaesth. 2005;94:107-11.

Fawcett W J, Haxby E J, Male DA. Magnesium: physiology and pharmacology. Br J Anaesth. 1999;83(2):302-20.

Ozalevli M, Cetin TO, Unlugenc H, Guler T, Isik G. The effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia. Acta Anaesthesiol Scand. 2005;49(10):1514-9.

Malleeswaran S, Panda N, Mathew P, Bagga R. A randomised study of magnesium sulphate as an adjuvant to intrathecal bupivacaine in patients with mild preeclampsia undergoing caesarean section. Int J Obstetric Anesth. 2010;19:161-6.

Yegin A, Sanli S, Hadimioglu N, Akbas M, Karsli B. Intrathecal fentanyl added to hyperbaric ropivacaine for transurethral resection of the prostate. Acta Anaesthesiol Scand. 2005;49:401-5.

Bigat Z, Boztug N, Karsli B, Cete N, Ertok E. Comparison of hyperbaric ropivacaine and hyperbaric bupivacaine in unilateral spinal anaesthesia. Clin Drug Investig. 2006;26(1):35-41.

Fettes PDW, Hocking G, Peterson MK, Luck JF, Wildsmith JAW. Comparison of plain and hyperbaric solutions of ropivacaine for spinal anaesthesia. Br J Anaesth. 2004;94(1):107-11.

Jabalameli M, Pakzadmoghadam SH. Adding different doses of intrathecal magnesium sulfate for spinal anesthesia in the cesarean section: A prospective double blind randomized trial. Adv Biomed Res. 2012 Aug;1:7.

Sultan MA, Shams TM, Mageed NA, El-Ebidy MG. Intrathecal hyperbaric ropivacaine versus hyperbaric bupivacaine in geriatric hypertensive patients. Benha M J. 2005;22(3):479.

Dayioğlu H, Baykara ZN, Salbes A, Solak M, Toker K. Effects of adding magnesium to bupivacaine and fentanyl for spinal anesthesia in knee arthroscopy. J Anesth. 2009;23(1):19-25.

Khaw KS, Kee WD, Wong M, Ng F, Lee A. Spinal ropivacaine for cesarean delivery: A comparison of hyperbaric and plain solutions. Anesth Analg. 2002;94:680-5.

Graf BM, Abraham I, Eberbach N, Kunst G, Stowe DF, Martin E. Differences in cardiotoxicity of bupivacaine and ropivacaine are the result of physicochemical and stereoselective properties. Anesthesiology. 2002;96:1427-34.

Knudsen K, Suurküla MB, Blomberg S, Sjövall J, Edvardsson N. Central nervous and cardiovascular effects of iv infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth. 1997;78(5):507-14.

Lysakowski C, Dumont L, Czametzki C, Tramer M. Magnesium as an adjuvant to postoperative analgesia: a systematic review of randomized trials. Anaesth Analg. 2007:104(6):1532-9

Qian XW, Chen XZ, Li DB. Low-dose ropivacaine-sufentanil spinal anaesthesia for caesarean delivery: a randomised trial. Int J Obstet Anesth. 2008;17(4):309-14.