Dr. ANJU PADMALAYAN PG

CO AUTHORS:Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof .Dr.GANESH PRABHU MD, DA ., Asst .Prof.Dr. SIVAPRASATH MD ., INSTITUTE OF ANAESTHESIOLOGYMADURAI MEDICAL COLLEGE

AIM.

To assess the efficacy of epidural magnesium for post operative analgesia.

REFERENCES Epidural magnesium reduces postoperative

analgesic requirement. British Journal of Anaesthesia 2007 98(4):519-523

Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post-operative analgesic requirements in patients undergoing major orthopedic surgery. Acta Anaesthesiologica scandinavica vol.51 issue 4, Mar 2007

Randomized double blinded study INCLUSION CRITERIA

40 Patients ASA I & IIAGE 20 -60 YearsHERNIOPLASTY

EXCLUSION CRITERIA ASA III&IV C/I for performing Regional anaesthesiaAdverse reaction to study medication

MATERIALS AND METHODS .. Ethical committee approval Informed written consent

Group F – Epidural FENTANYL 2mics/ml in 10 ml NS

Group FM– Epidural FENTANYL 2mics /ml + MAGNESIUM SULPHATE 50mg in 10 ml NS

CLINICAL PROTOCOL..

MONITORS: NIBP, Pulseoximetery PRE LOADING: 500 ml RL sol

TECHNIQUE

Patient in Right lateral position

Under strict aseptic precaution ,

Epidural performed with 16 G tuohy needle with loss of resistance to air

Catheter threaded

Test dose given

Cont..

SAB performed in a space below injecting 0.5% hyperbaric Bupivacaine,

Surgery proceeded After the completion of the surgery Pt observed in the IRCU

PARAMETERS OBSERVED ..

Pulse rate Blood pressure Oxygen saturation Ventilator requirement Duration of analgesia Sedation score Visual analogue score Side effects

VISUAL ANALOGUE SCORE: 0 – 10 NO PAIN

LITTLE PAINCONSIDERABLE PAINLOT OF PAINWORST PAIN

  RAMSAY SEDATION SCORE: LEVELS 1 -3 patient awake LEVEL 1-anxious and agitated or restless or both LEVEL 2-cooperative and oriented LEVEL 3-responds to commands only  LEVEL 4-6 patient asleep, responds to light glabellar tap

or loud auditory stimulus LEVEL 4 –Brisk response LEVEL 5 – Sluggish response LEVEL 6 –No response

STATISTICAL TOOLS

Data analysis was done with the help of computer using Epidemiological Information Package (EPI 2008).

Kruskul Wally’s chi square was used to test the significance of relationship. A ‘p’ value less than 0.05 is taken to denote significant relationship .

RESULTS ..

Two groups were comparable for their demographic data and baseline hemodynamic variable .

DATA COLLECTED .

GROUP FM F ‘P’

AGE IN YRS 39.2±9.9 40.2± 8.4 0.7341Not significant

SEXMALEFEMALE

90%10%

90%10%

1.0Not significant

MEAN AGE (in years)

PULSE RATE

PULSE RATE

AT

FM GROUP F GROUP “p”

0 minute 87 + 9.1 86.5 + 10.5 0.9028 Not

significant

30 minutes 84.5 + 13.7 93.8 + 14.6 0.0445 Significant

60 minutes 77.9 + 11.0 101 + 16.2 0.0001 Significant

120 minutes 73.1 + 7.7 101.7 + 16.1 0.0001 Significant

180 minutes 72.8 + 7.5 101.7 + 14.2 0.0001 Significant

PULSE RATE

SYSTOLIC BLOOD PRESSURE

SYSTOLIC B.P.

AT

FM GROUP F GROUP “p”

0 minute 119.7 + 10.7 124.1 + 11.4 0.1967 Not significant

30 minutes 117.4 + 9.2 120.5 + 9 0.2179 Not significant

60 minutes 115.2 + 7.4 118 + 7.3 0.3584 Not significant

120 minutes 115.7 + 8.4 118.5 + 8 0.2333 Not significant

180 minutes 120.2 + 7.4 122.7 + 4.7 0.4703 Not significant

SYSTOLIC BLOOD PRESSURE

DIASTOLIC BLOOD PRESSURE

DIASTOLIC B.P.

AT

FM GROUP F GROUP “p”

0 minute 90 + 6.2 87.6 + 6.6 0.2872 Not significant

30 minutes 85.3 + 5.4 85.4 + 5.5 0.845 Not significant

60 minutes 85.7 + 4.9 89.3 + 5.3 0.8057 Not significant

120 minutes 86.4 + 4.9 86.6 + 5.2 0.9673 Not significant

180 minutes 86.6 + 4.4 86.5 + 5.4 0.7746 Not significant

DIASTOLIC BLOOD PRESSURE

OXYGEN SATURATION

VARIABLE FM GROUP F GROUP “p”

SPO2 98.4 + 0.9 98.5 + 1.1 0.6896

Not significant

SPO2

SEDATION SCORE

SEDATION SCORE FM GROUP F GROUP

No. % No. %

3 10 50 7 35

4 10 50 13 65

Total 20 100 20 100

Mean

S.D.

3.5

0.51

3.65

0.49

‘p’ 0.3434

Not Significant

SEDATION SCORE

VISUAL ANALOGUE SCORE

VAS

AT

FM GROUP F GROUP “p”

0 minute 3.1 + 1.3 2.7 + 1.0 0.3126

Not significant

30 minutes 0.15 + 0.37 0.65 + 0.49 0.0014 Significant

60 minutes 0.2 + 0.41 0.8 + 0.4 0.0013 Significant

120 minutes 2.75 + 0.96 3.4 + 0.68 0.0271 Significant

180 minutes 3.4 + 0.88 3.95 + 0.22 0.0214 Significant

VISUAL ANALOGUE SCALE

ONSET OF ANALGESIA

There was no significant difference in the onset of analgesia in both groups.

ANALGESIA DURATION .

VARIABLE FM GROUP F GROUP “p”

Duration of

analgesia

( in minutes)

148.7 + 34.4 128.5 + 28.7 0.0295

Significant

DURATION OF ANALGESIA ( in minutes)

DISCUSSION . Magnesium sulphate – Non competitively

antagonizes NMDA receptor channels. Non-competitive NMDA receptor

antagonists can have an effect on pain when used alone, but it has also been shown that they can reveal the analgesic properties of opioids.

Magnesium supplement enhances the

analgesic effect of opioids

NMDA RECEPTORS NMDA receptors –central nociceptive

transmission

Recent studies show NMDA receptors are also present in skin, muscles & knee jt

Mg- physiological blocker of NMDA

In inactive state NMDA receptor is blocked by centrally positioned Mg ion

TO SUMMARISE . The purpose of this study is to assess the

efficacy of epidural magnesium. Study..

Postoperative analgesic duration

Group F 128.50 min , FM 148.70 min.

Group FM had prolonged duration of analgesia.

TO CONCLUDE .

Magnesium when given epidurally along with opioids will increase the duration of analgesia without any side effects.

Magnesium potentiates the analgesic property of opioids and hence the quality of analgesia.

Thank You