Article Data

  • Views 1068
  • Dowloads 133

Original Research

Open Access

Effects of epidural magnesium sulphate on intraoperative sufentanil and postoperative analgesic requirements in thoracic surgery patients

  • JANA KOGLER1
  • MLADEN PERIĆ1
  • PERO HRABAČ2
  • VILKA BEKAVAC-MIŠAK1
  • MAJA KARAMAN-ILIĆ31

1Department of Anesthesiology, Reanimatology and Intensive Care, Zagreb University Hospital Centre, Zagreb, Croatia

2University of Zagreb School of medicine, Croatian Institute for Brain Research, Zagreb, Croatia

3Department of Anesthesiology, Reanimatology and Intensive care, Clinical Hospital "Sveti Duh", Zagreb, Croatia

DOI: 10.22514/SV111.052016.4 Vol.11,Issue 1,May 2016 pp.56-73

Published: 02 May 2016

*Corresponding Author(s): JANA KOGLER E-mail: jkogler1974@yahoo.com

Abstract

Introduction. Thoracic surgery is associated with high levels of pain.

Magnesium has antinociceptive effects in animal and human models of pain.

Objectives. The aim of this randomized prospective study was to assess the effects of continuous epidural magnesium infusion during thoracic surgery on intraoperative sufentanil consumption and postoperative analgesic requirements during the first 48 hours after surgery.Materials and methods. Seventy patients were randomized into two groups of 35 patients: Group 1 (magnesium group) received an epidural with 10% magnesium sulfate (MgSO4) along with anesthetic drugs

(midazolam, propofol, rocuronium, sufentanil, levobupivacain), and group 2 (control group) received an epidural with 0.9% sodium chloride (NaCl) solution along with anesthetic drugs intraoperatively. Postoperatively, group 1 patients were administered the 10% magnesium sulfate epidural in addition to a local anesthetic and opioid, whereas group 2 patients were administered the local anesthetic and opioid alone. Primary outcomes of the study were to determine the cumulative doses of intraoperatively administered sufentanil and cumulative doses of sufentanil and levobupivacaine administered during the first 48 h postoperatively.

Secondary outcomes were a visual analog scale (VAS) score for rest and movement every 4 hours, level of sedation, cardiovascular, respiratory and neurological complications, incidence of postoperative shivering, nausea and vomiting and global patient satisfaction.

Results. The cumulative sufentanil dose required intraoperatively was significantly lower in the magnesium group: 43.00 µg vs 56.3 µg ( p = 0.001). VAS scores measured every 4 hours at rest and movement during the first 48 hours postoperatively, cumulative analgesic consumption, incidence of shivering, nausea and vomiting were significantly lower in the magnesium group. The global satisfaction score was significantly higher in the magnesium group (4.3 vs 3.7; p = 0.005).

Conclusion. The addition of magnesium in the epidural mixture of sufentanil and levobupivacaine led to more efficient intraoperative and postoperative analgesia, lower sufentanil and levobupivacaine consumption, lower incidence of postoperative shivering, nausea and vomiting. Epidural with magnesium appears to be a useful adjunct to anesthetic drugs, which can exert positive effects on the course and outcome of thoracic surgery patients.

Keywords

thoracic surgery, postthoracotomy pain, perioperative analgesia, magnesium

Cite and Share

JANA KOGLER,MLADEN PERIĆ,PERO HRABAČ,VILKA BEKAVAC-MIŠAK,MAJA KARAMAN-ILIĆ. Effects of epidural magnesium sulphate on intraoperative sufentanil and postoperative analgesic requirements in thoracic surgery patients. Signa Vitae. 2016. 11(1);56-73.

References

1. Kaplan JA, Slinger PD. Thoracic Anaesthesia. 3rd. ed. New York: Churchill Livingstone; 2003.

2. Ballantyne JC, Carr DB, de Ferranti S, Suarez T, Lau J, Chalmers TC, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Anal 1998; 86(3):598-612.

3. Gottschalk A, Cohen S, Yang S, Ochroch EA. Preventing and treating pain after thoracic surgery. Anesthesiology 2006;104:596-600.

4. Konrad M, Schlingmann KP, Gudermann T. Insights into the molecular nature of magnesium homeostasis. Am J Physiol Renal Physiol 2004;286 (4):599-605.

5. Dickenson AH. Spinal cord pharmacology of pain. Br J Anaesth

1995;75(2):193-200.

6. Mc Kartney CJ, Sinha A, Katz J. A qualitative systematic review of the role of N –methyl – D-aspartate receptor antagonists in preventive analgesia. Anesth Analg 2004;98:1385-400.

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

8. Buvanendran A, McCarthy RJ, Kroin JS, Leon GW, Perry P, Turkman JK. Intrathecal magnesium prolongs fentanyl analgesic a prospective, randomized, controlled trial. Anesth Analg 2002;95:661-7.

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

10. Ulungenc H, Ozalevil M, Gunduz M, Gunasti S, Urunsak IF, Guler T, Isik

G. Comparison of intrathecal magnesium, fentanyl, or placebo combined with bupivacain 0,5% for parturients undergoing elective cesarean delivery. Acta Anaesthesiol Scand 2009;53(3):346-53.

11. Conacher ID. Post-thoracotomy analgesia. Anest Clin North Am

2001;19(3):611-25.

12. Ochroch EA, Gottschalk A, Angostides J. Long-term pain and activity during recovery from major thoracotomy using thoracic epidural analgesia. Anesthesiology 2002;97:1234-44.

13. Fawcett WJ, Haxby EJ, Male DA. Magnesium: physiology and pharmacology. Br J Anaesth 1999;83:302-20.

14. El-Kerdawy H. Analgesic requirements for patients undergoing lower extremity orthopedic surgery – the effect of combined spinal and epidural magnesium. Middle East J Anesthesiol 2008;19(5):1013-25.

15. Sun J, Wu X, Xu X, Jin L, Han N, Zhou R. A comparison of epidural magnesium and/or morphine with bupivacain for postoperative analgesia after cesarean section. Int J Obstet Anesth 2012;21(4):310-6.

16. Ghatak T, Chandra G, Malik A, Singh D, Bhatia VK. Evaluation of the effect of magnesium sulphate vs. clonidine as adjunct to epidural bupivacaine. Indian J Anaesth 2010;54(4):308-13.

17. Arcinoni R, Palmisani S, Tigano S, Santorsola C, Sauli V, Romano S, et al. Combined intrahecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post-operative analgesic requirements: a prospective, randomized, double-blind, controlled trial in patients undergoing major orthopedic surgery. Acta Anaesthesiol Scan

2007;51(4):482-9.

18. Saadawy IM, Kaki AM,Abd EL Latif AA, Abd-Elmaksoud AM, Tolba OM. Lidocain vs. Magnesium: effect on analgesia after a laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2010;54:549-56.

19. Oguzhan N, Gunday I, Turan A. Effect of magnesium sulphate infusion on sevoflurane consumption, hemodynamics, and perioperative opioid consumption in lumbar disc surgery. J Opioid Manag 2008;4:105-10.

20. Farouk S. Pre-incisional epidural magnesium provides pre-emptive and preventive analgesia in patients undergoing abdominal hysterectomy. Br J Anaesth 2008;10185:694-99.

21. Gupta DS, Mitra K, Mukherjee M, Suddhadeb R, Aniruddha S, Sudeshna K, et al. Effect of magnesium infusion on thoracic epidural analgesia. Saudi J Anaesth 2011;5(1):55-61.

22. Kim SM, Cho SH, Kim SH, Lee DG, Chae WS, Jin HC. The effects of epidural magnesium on postoperative pain management in patients with patient-controlled epidural analgesia after thoracotomy. Korean J Anesthesiol 2009;57(4):466-71.

23. Kogler J. The analgesic effect of magnesium sulfate in patients undergoing thoracotomy. Acta Clin Croat 2009;48:9-16.

24. Lee JH, Yang WD, Han SY, Noh JI, Cho SH, Kim SH, et al. Effect of epidural magnesium on the incidence of chronic postoperative pain after video-assisted thoracic surgery. J Cardiothorac Vasc Anesth

2012;26(6):1055-9.

25. Goodman EJ, Haas AJ, Kantor GS. In advertent administration of magnesium sulphate through epidural catheter: report and analysis of a drug error. Int J Obs Anesth 2006;15:63-7.

26. Lejuste MJ. Inadvertent intrathecal administration of magnesium sulphate. S Afr Med J 1985;64:715-30.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top