EPIDURAL magnesium for post operative analgesia. CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof . Dr.GANESH PRABHU MD, DA ., Asst . Prof.Dr . SIVAPRASATH MD ., INSTITUTE OF ANAESTHESIOLOGY MADURAI MEDICAL COLLEGE. Dr. ANJU PADMALAYAN PG. AIM.
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EPIDURAL magnesium for post operative analgesia. CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof .Dr.GANESH PRABHU MD, DA ., Asst .Prof.Dr. SIVAPRASATH MD ., INSTITUTE OF ANAESTHESIOLOGY MADURAI MEDICAL COLLEGE Dr. ANJU PADMALAYAN PG
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. ActaAnaesthesiologicascandinavica vol.51 issue 4, Mar 2007
Randomized double blinded study • INCLUSION CRITERIA • 40 Patients • ASA I & II • AGE 20 -60 Years • HERNIOPLASTY • EXCLUSION CRITERIA • ASA III&IV • C/I for performing Regional anaesthesia • Adverse 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 PAIN CONSIDERABLE PAIN LOT OF PAIN WORST 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 .
ONSET OF ANALGESIA • There was no significant difference in the onset of analgesia in both groups.
DISCUSSION . • Magnesium sulphate – Non competitively antagonizes NMDA receptor channels. • Non-competitive NMDA receptor antagonists can have an effecton pain when used alone, but it has also been shown that theycan reveal the analgesic properties of opioids. • Magnesium supplement enhances theanalgesic 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.