Magnesium Sulphate in the Ultrasound-guided Supraclavicular Brachial Plexus Block
Condition: Pain
Study type: Interventional
Phase: Phase 2

Summary: 
      This study evaluated the motor and sensory block duration and the postoperative analgesic
      effects of adding Magnesium Sulphate to bupivacaine in the ultrasound-guided supraclavicular
      brachial plexus block Anesthesia. Motor and sensory block duration were considered as a
      primary endpoint.
    

Detailed description: 
      The supraclavicular approach to the brachial plexus provides more consistent and effective
      regional anesthesia to the upper extremity than other approaches to brachial plexus blockade.
      However, the fear of pneumothorax is often cited by anesthetists as a reason to avoid this
      approach. With increasing affirmation on patient safety and better patient outcomes,
      ultrasound guided regional anesthesia (UGRA) is becoming more widely popular. Ultrasound
      provides clinicians with a real time image suitable for visualizing anatomical structures,
      needle placement, and local anesthetic spread. Ultrasound-guidance to supraclavicular
      brachial plexus block has shown to increase success rates, reduce the volume of local
      anesthetic (LA) used and has the potential to minimize the risk of complications.

      Although there are many treatment choices for postoperative pain, a gold standard has not
      been established. Prolonging the duration of peripheral nerve blocks using long-acting Local
      Anesthesia or perineural catheters can be used. However, perineural catheters are more
      time-consuming, costly, has possible higher complication rates (e.g. Infection), and needs
      more postoperative care.

      Several adjuvants such as fentanyl, alpha-2 adrenergic agonists (clonidine or
      dexmedetomidine), tramadol, and magnesium have been used to extend the duration of peripheral
      nerve blocks. 5-7 Magnesium has antinociceptive effects in animal and human models,
      principally related to blocking the N-methyl-D-aspartate (NMDA) receptors and regulation of
      calcium influx into cells. Calcium influx leads to a sequence of central sensitization such
      as windup phenomenon and long term potentiation which are crucial mechanisms that determine
      the duration and intensity of post-operative pain. Magnesium prevents central sensitization
      triggered by peripheral nociceptive stimulation in response to painful stimuli.

      The investigators designed this study to evaluate the effect of adding magnesium sulphate to
      bupivacaine in the ultrasound-guided supraclavicular brachial plexus block anesthesia. The
      sensory and motor block durations were evaluated as primary endpoints and the postoperative
      analgesic effects as a secondary endpoint.
    

Intervention name(s): Magnesium Sulphate
Intervention type(s): Drug
Intervention description(s): Magnesium has antinociceptive effects in animal and human models, principally related to blocking the N-methyl-D-aspartate (NMDA) receptors and regulation of calcium influx into cells.
Other intervention name(s): Bupivacaine HCL 0.5%
Intervention MeSH terms: Magnesium Sulfate; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Diagnostic