DOI: http://dx.doi.org/10.18203/2349-2902.isj20194048

A prospective randomized controlled trial to study the effect of preoperative and intraoperative magnesium over postoperative ileus and postoperative pain in major non–laparoscopic abdominal surgeries

A. R. Vishal Varma Bathina, Rama Krishna Peetani, Viswa Teja Vaitla

Abstract


Background: The objective of the study were postoperative pain on 1st postoperative hour and 2, 4, 12, 24th postoperative hour as per numeric rating scale (NRS); total dose of postoperative analgesic consumption; postoperatively time of first appearance of bowed sounds; postoperatively time of first passage of flatus.

Methods: A randomized controlled study will be performed. Patients of ASA 1 and 2, scheduled for major abdominal (GI) surgery, were divided into magnesium group and control group. Serum magnesium levels are estimated in both groups. Magnesium group receives 40 mg/kg of magnesium sulfate in 100 cc NS 30 minutes before the induction* as Intravenous drip, followed by 10 mg/kg/hr during the intraoperative hours. Control group receives the same volume of isotonic saline solution. Intra-operative hemodynamic parameters are evaluated constantly by recording pulse rate, blood pressure and Spo2. Further, post- operative analgesic will be ensured by epidural top-up using bupivacaine and tramadol when patients complaints of pain or when monitored with numeric rating scale (NRS). Postoperative patient pain is going to be evaluated in post-anesthetic care unit (PACU)/ SICU by numeral rating scale (NRS) during 1st hour, 2nd hour, 4th hour, 12th hour and 1 day, total dose of post-operative analgesic consumption will be recorded.

Results: Of the 60 patients studied, 30 belong to magnesium group for which pre-operative and intraoperative intravenous magnesium (cases). Remaining 30 were given equal amounts of preoperative and intraoperative normal saline given (controls).

Conclusions: The results of present study suggests that pre and intra operative. Magnesium as an adjunct to epidural analgesia reduces postoperative pain pre-operative and intra operative IV mg reduces post-operative ileus duration.


Keywords


Preoperative and intraoperative, Magnesium, Postoperative ileus, Pain, Non–laproscopic abdominal surgeries

Full Text:

PDF

References


Benzon HA, Shah RD, Benzon HT. Magnesium is an antagonist of NMDA receptors and minimizes the perception and duration of pain. Essentials of pain medicine chapter 12. 2018: 111–116.

Woolf CJ, Thompson SW. the induction and maintance of central sencitization is dependent on N-methyl – D – Aspartic and receptor activation; implications for the treatment of post Injury pain. Hypersensitivity states. Pain. 1991;44(3):293–9.

Kulaylat MN, Doerr RJ. Small bowel obstruction. In: Holzheimer RG, Mannick JA, eds. Surgical treatment: evidence-based and problem-oriented. Munich: Zuckschwerdt; 2001.

Benzon HT, Fishman S, Liu S, Cohen SP, Raja SN. Essentials of Pain Medicine. Elsevier Inc; 2011.

Benhaj AM, Barakette M, Dhatri S, Ouezini R, Lamine K, Jebali A, et al. Effect of intra and postoperative magnesium sulphate infusion on postoperative pain. Tunis Med. 2008;86:550-5.

Nimmo WS, Heading RC Wilson. J. Tothill P, Prescott LF. Inhibition of gastric emptying and drug absorption by marcotic analgesics. Br J Clin Pharmacol. 1975;2(6):509–13.

Khalil G, Janghorbani M, Sajedip, Ahmadi G. Effects of adjuvant intrathecal magnesium sulphate to bupivacaine for spinal anewthesia; arandomised double blinded trial. J Anaesth. 2011;25(6):892–7.

Fotiadis RJ. Badvie S. Weston. MD Allen – Mersh. TG: Epidural analgesia in gastrointestinal surgery. Br. J. Surgery. 2004;91(7):828–41.

Tramer MR, Schneider J, Marti RA, Rifat K. Role of magnesium sulfate in postoperative analgesia. Anesthesiology. 1996;84(2):340-7.

Peng YN, Sung FC, Huang ML, Lin CL, Kao CH. The use of intravenous magnesium sulfate on postoperative analgesia in orthopedic surgery: A systematic review of randomized controlled trials. Med (Baltimore). 2018;97(50):e13583.