title: A comparison of epidural magnesium and/or morphine with bupivacaine for postoperative analgesia after cesarean section.
abstract: BACKGROUND
  Magnesium can potentiate the antinociceptive effect of morphine. This prospective randomized double-blinded study was undertaken to establish the analgesic effect of adding magnesium to epidural morphine during cesarean section.
  
  
  METHODS
  Two hundred patients undergoing cesarean section under combined spinal-epidural anesthesia were recruited. After administration of intrathecal bupivacaine 10mg, patients were randomly assigned to receive one of four epidural study solutions: 0.1% bupivacaine 10 mL (Group B); 0.1% bupivacaine 10 mL and morphine 1.5mg (Group B+Mor); 0.1% bupivacaine 10 mL and magnesium 500 mg (Group B+Mg); or 0.1% bupivacaine 10 mL morphine 1.5mg and magnesium 500 mg (Group B+Mor+Mg). The primary outcome was the area under the curve for visual analog scale pain scores during 36 h postoperatively. Secondary outcomes included time to the use of rescue analgesics, patient satisfaction and side effects.
  
  
  RESULTS
  Patients in Group B+Mor+Mg had lower for pain scores and area under the curve pain scores both at rest and on movement, increased time for first analgesic request, and increased satisfaction score at 24h after surgery.
  
  
  CONCLUSIONS
  Addition of magnesium 500 mg and morphine 1.5mg to epidural 0.1% bupivacaine 10 mL reduced postoperative pain compared with addition of morphine or magnesium alone or no additive.
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical College, Wenzhou, China. sun_jiehao@126.com
authors.forename: Jiehao
authors.initials: J
authors.lastname: Sun
authors.forename: Xiuying
authors.initials: X
authors.lastname: Wu
authors.forename: Xuzhong
authors.initials: X
authors.lastname: Xu
authors.forename: Lielie
authors.initials: L
authors.lastname: Jin
authors.forename: Ning
authors.initials: N
authors.lastname: Han
authors.forename: Riyong
authors.initials: R
authors.lastname: Zhou
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000770:Anesthesia, Endotracheal; D019540:Area Under Curve; D002045:Bupivacaine / Q000627:therapeutic use*; D002585:Cesarean Section; D004311:Double-Blind Method; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D009020:Morphine / Q000627:therapeutic use*; D010147:Pain Measurement / Q000379:methods / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000188:drug therapy*; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D008278:Magnesium Sulfate; D009020:Morphine; D002045:Bupivacaine