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EVALUATION OF INTRAVENOUS MAGNESIUM SULPHATE FOR POSTOPERATIVE ANALGESIA IN ELECTIVE LOWER LIMB ORTHOPAEDIC SURGERIES UNDER SPINAL ANAESTHESIA
ABSTRACT
BACKGROUND
Poorly managed postoperative pain remains a major cause of morbidity and mortality.
Effective postoperative pain relief has not been achieved with the established methods of pain
relief.
Magnesium sulphate is an N-methyl-D-aspartate receptor antagonist and a calcium
channelblocker. There are conflicting reports about the effectiveness of magnesium sulphate
as an adjuvant analgesic.
The objective of this study was to evaluate the effect of magnesium sulphate for postoperative
pain relief in patients scheduled for elective lower limb orthopaedic surgeries under spinal
anaesthesia.
PATIENTS AND METHODS
Following the approval of the institutions Ethical Review Committee, eighty-eight (88)
consenting patients scheduled for lower limb orthopaedic surgeries under spinal anaesthesia
were recruited into the study. The study group consisting of 44 patients received bolus
intravenous magnesium sulphate of 30mg/kg over 15min after spinal anaesthesia which was
followed by a continuous infusion dose of 10mg/kg/hr till the end of surgery. The control group
received same volume of isotonic saline over same period. After surgery, intravenous pethidine
at 1mg/kg slowly over 10 minutes was administered every 4hrs and intravenous paracetamol
15mg/kg every 6hrs was also administered for pain control. Rescue analgesic in the form of
intravenous pethidine slowly over 10 minutes was administered on patient request or on
recording of at least 2 or more pain scores higher than the previous value. Postoperative pain
scores at immediate postoperative period, 30min, 1hr, 2hr, 4hr, 8hr, 16hr and 24hr
postoperatively were evaluated using verbal rating scale. The total 24hr opioid (pethidine)
consumption in both groups was also noted and compared. Total duration of analgesia and
incidence of side effects of magnesium sulphate was also determined.
RESULTS
Postoperative pain scores were significantly lower in group A(study group) at 30min, 1hr,
2hr, 4hr, 8hr, 16hr and 24hr after surgery with p-values of 0.039,
0.001,0.001,0.001,0.001,0.001 and 0.001 respectively. The 24hr-opioid(pethidine)
consumption was significantly less in the study group compared to the control group
[144mg(124.0mg-165.0mg) versus 265mg(225.0mg-300.0mg);p<0.001] . Also, the duration
of analgesia was significantly prolonged in the study group compared to the control
(296.07±82.98mins versus 177.84±32.28mins; p< 0.001). Time to first request for analgesic
was significantly prolonged in the study group compared to the control group (327.66±99.90
versus 194.02±30.41; p< 0.001). Time of L1 sensory loss was significantly prolonged in the
control group compared to the study group(4.93±1.33mins versus 4.00±1.33mins; p=0.003).
However, the highest levels of sensory loss achieved by patients in the two groups were
comparable, T10 (T8-T10). The onset of motor block was shorter in the study group
compared to the control group with more patients in the study group having a higher
Modified Bromage Score of 3 compared to the control group at the 2th, 5th ,10th ,15th and 20th
minutes after local anaesthetic agent have been injected into the subarachnoid space. P-values
at these periods were 0.134, 0.203, 1.000, 0.916 and 0.916 respectively. Also, thedegreeof
motor block was more and duration longer with patients in the study group compared to
patients in the control group. There were more patients in the study group having a higher
MBS of 3 at the immediate postoperative period, 30th, 60th, 90th , 120th, 150th and 180th
minutes postoperatively. P-values at these postoperative periods were 0.321, 0.054, 0.020,
0.015, 0.823, 0.302 and 0.043 respectively. There was no incidence of side effect of
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magnesium sulphate administration observed in the study group. However, 7 patients
representing 15.9% of patients in the control group had postoperative shivering compared to
3 patients representing 6.8% of patients in the study group(P=0.179). But this was not
statistically significant. There was no incidence of flushing, hypotension, headache, nausea,
vomiting and dizziness.Finally, satisfaction with analgesia was significantly higher in the
study group compared to the control group (p< 0.001).
CONCLUSION
Intravenous magnesium sulphate used as adjuvant analgesic in patients scheduled for elective
lower limborthopaedic surgeries under subarachnoid block improved postoperative analgesia
and reduced postoperative opioid consumption with no recorded side-effects.
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