Skip Navigation

If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".

Electronic Letters to:

Regional Anaesthesia:
A. Bilir, S. Gulec, A. Erkan, and A. Ozcelik
Epidural magnesium reduces postoperative analgesic requirement
Br. J. Anaesth. 2007; 98: 519-523 [Abstract] [Full text] [PDF]
*E-letters: Submit a response to this article

Electronic letters published:

[Read E-letter] Epidural Magnesium
Krishnan Melarkode   (22 April 2007)

Epidural Magnesium 22 April 2007
Top
Krishnan Melarkode,
Specialist Registrar
Cambridge,UK

Send letter to journal:
Re: Epidural Magnesium

Editor – It was interesting to read the study article by Bilir A, Gulec S, Erkan A and Ozcelik A on the use of epidural magnesium for post operative analgesia ¹. I would like to highlight few points which I feel needs to be clarified.

In the first instance, it is very important to caution all anaesthetists as the use of magnesium sulphate via the epidural route may not be licensed in the UK. After having clarified with our hospital pharmacy, it is very clear that the presently available preparation of magnesium sulphate is not licensed for use epidurally (in our hospital). There are many companies manufacturing magnesium sulphate and hence it is prudent for all anaesthetists to clarify this before they embark on using magnesium sulphate epidurally.

Secondly, I wonder why the epidural infusion was stopped after a duration of only 24 hours post operatively in patients who had hip replacement. Also, the authors have not clarified about further analgesia after stopping the epidural infusion. How wise is it to stop the epidural in patients with hip replacement after only 24 hours? This may have compromised the quality the analgesia subsequently and also probably would have not helped with early physiotherapy.

The visual analogue score (VAS) was statistically significant post operatively at the end of the first hour only. Subsequently, although the VAS was less in the fentanyl plus magnesium group, patients still had pain scores ranging from 1 to 4 in the 24 hour duration of the study. So, was the addition of magnesium sulphate really effective in keeping patients pain free?

The authors have also not given details of the percentage of patients with VAS during their regular assessments in the study period.

With so many questions to answer, we have to be cautious regarding the use of magnesium sulphate epidurally.

References: 1. Bilir A, Gulec S, Erkan A, Ozcelik A. Epidural magnesium reduces postoperative analgesic requirement. Br J Anaesth 2007; 98 (4): 519-23.

Conflict of Interest:

None declared