Evaluation of magnesium sulphate in combination with dexmedetomidine as adjuvants to levobupivacaine in ultrasound-guided spermatic cord block: a randomized controlled trial

Abstract

Background: Several agents have been added to local anesthetics to increase the quality of anesthesia and to prolong postoperative analgesia. The current study investigated the effect of using dexmedetomidine and magnesium sulphate as additives to levobupivacaine 0.5% for spermatic cord block (SCB) anesthesia in testicular sperm extraction (TESE) surgery.

Methodology: It was a prospective, randomized double-blind study, performed on 113 subjects undergoing TESE surgery using local anesthesia. 

The subjects were randomly divided into four groups. Bilateral SCB was performed for each patient using levobupivacaine 0.5% 18 mL in combination to 2 mL of either normal saline (Group C), dexmedetomidine 1 μg/kg (Group D), magnesium 100 mg (Group M), or a mixture of the same doses of both magnesium and dexmedetomidine (Group MD) according to the group assignment. Patients were compared according to the time of first analgesic dose, and analgesic intake in the first 24 h.

Results: The time elapsed till receiving the first analgesic dose was noted to be longer in the Group MD when compared to those in the Groups C, M and D, (20 ± 1.5 vs 9 ± 1.5, 14.4 ± 2.3 and 15.6 ± 2.2 h, respectively; P < 0.001). Moreover, the requirement of postoperative analgesia was noticeably lower in the Group MD when compared to the other groups. 

Conclusion: Using magnesium and dexmedetomidine as additives to levobupivacaine for   ultrasound-guided spermatic cord block prolonged postoperative analgesia, and decreased the total postoperative analgesic consumption.

Abbreviations: SCB - spermatic cord block; TESE - testicular sperm extraction; US-SCB - ultrasound-guided SCB

Key words: Dexmedetomidine; Levobupivacaine; Magnesium; Spermatic cord block; Testicular sperm extraction

Citation: Wahdan AS, Moussa AA, Farag MA, Salama AK. Evaluation of magnesium sulphate in combination with dexmedetomidine as adjuvants to levobupivacaine in ultrasound-guided spermatic cord block: a randomized controlled trial. Anaesth. pain intensive care 2022;26(2): 182–190 ; DOI: 10.35975/apic.v26i2.1836

Received: August 13, 2021, Reviewed: January 20, 2022, Accepted: February 12, 2022