The Effect of Systemic and Regional Use of Magnesium Sulfate on Postoperative Tramadol Consumption in Lumbar Disc Surgery

Melek Demiroglu, Canan Ün, Dilsen Hatice Ornek, Oya Kıcı, Ali Erdem Yıldırım, Eyup Horasanlı, Semih Başkan, Emel Fikir, Mehmet Gamli, Bayazit Dikmen, Melek Demiroglu, Canan Ün, Dilsen Hatice Ornek, Oya Kıcı, Ali Erdem Yıldırım, Eyup Horasanlı, Semih Başkan, Emel Fikir, Mehmet Gamli, Bayazit Dikmen

Abstract

Aim: To investigate the effect of magnesium administered to the operative region muscle and administered systemically on postoperative analgesia consumption after lumbar disc surgery.

Material and method: The study included a total of 75 ASA I-II patients aged 18-65 years. The patients were randomly allocated into 1 of 3 groups of 25: the Intravenous (IV) Group, the Intramuscular (IM) Group, and the Control (C) Group. At the stage of suturing the surgical incision site, the IV Group received 50 mg/kg MgSO4 intravenously in 150 mL saline within 30 mins. In the IM Group, 50 mg/kg MgSO4 in 30 mL saline was injected intramuscularly into the paraspinal muscles. In Group C, 30 mL saline was injected intramuscularly into the paraspinal muscles. After operation patients in all 3 groups were given 100 mg tramadol and 10 mg metoclopramide and tramadol solution was started intravenously through a patient-controlled analgesia device. Hemodynamic changes, demographic data, duration of anesthesia and surgery, pain scores (NRS), the Ramsay sedation score (RSS), the amount of analgesia consumed, nausea- vomiting, and potential side effects were recorded.

Results: No difference was observed between the groups. Nausea and vomiting side effects occurred at a rate of 36% in Group C, which was a significantly higher rate compared to the other groups (p < 0.05). Tramadol consumption in the IM Group was found to be significantly lower than in the other groups (p < 0.05).

Conclusion: Magnesium applied to the operative region was found to be more effective on postoperative analgesia than systemically administered magnesium.

Figures

Figure 1
Figure 1
Measurements taken from 5 minutes to 24 hours postoperatively for mean arterial pressure between the groups.
Figure 2
Figure 2
Measurements taken from 5 minutes to 24 hours postoperatively for SpO2 values between the groups.
Figure 3
Figure 3
Measurements taken from 5 minutes to 24 hours postoperatively for heart rate values between the groups.

References

    1. Kehlet H. Postoperative pain relief—what is the issue? British Journal of Anaesthesia. 1994;72(4):375–378. doi: 10.1093/bja/72.4.375.
    1. Coderre T. J., Katz J., Vaccarino A. L., Melzack R. Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain. 1993;52(3):259–285. doi: 10.1016/0304-3959(93)90161-h.
    1. Fawcett W. J., Haxby E. J., Male D. A. Magnesium: physiology and pharmacology. British Journal of Anaesthesia. 1999;83(2):302–320. doi: 10.1093/bja/83.2.302.
    1. Begon S., Pickering G., Eschalier A., Dubray C. Magnesium increases morphine analgesic effect in different experimental models of pain. Anesthesiology. 2002;96(3):627–632. doi: 10.1097/00000542-200203000-00019.
    1. Novak L., Bregesttovski P., Ascher P., Herbert A., Prochertz A. Magnesium gates glutamat-activated channels in mouse central neurones. Nature. 1984;337:462–465.
    1. Cheng J.-K., Lai Y.-J., Chen C.-C., Cheng C.-R., Chiou L.-C. Magnesium chloride and ruthenium red attenuate the antiallodynic effect of intrathecal gabapentin in a rat model of postoperative pain. Anesthesiology. 2003;98(6):1472–1479. doi: 10.1097/00000542-200306000-00026.
    1. Lawand N. B., Willis W. D., Westlund K. N. Excitatory amino acid receptör involvement in peripheral nociceptive transmission in rats. European Journal of Pharmacology. 1997;324(2-3):169–177. doi: 10.1016/s0014-2999(97)00072-1.
    1. McBain C. J., Mayer M. L. N-methyl-D-aspartic acid receptor structure and function. Physiological Reviews. 1994;74(3):723–760.
    1. Woolf C. J. Somatic pain-pathogenesis and prevention. British Journal of Anaesthesia. 1995;75(2):169–176. doi: 10.1093/bja/75.2.169.
    1. Iwatsu O., Ushida T., Tani T., Lawand N. B., Yamamoto H. Peripheral administration of magnesium sulfate and ketamine hydrochloride produces hypesthesia to mechanical stimuli in humans. Journal of Health Science. 2002;48(1):69–72. doi: 10.1248/jhs.48.69.
    1. Cairns B. E., Svensson P., Wang K., et al. Activation of peripheral NMDA receptörs contributes to human pain and rat afferent discharges evoked by injection of glutamate into the masseter muscle. Journal of Neurophysiology. 2003;90(4):2098–2105. doi: 10.1152/jn.00353.2003.
    1. Sanchez-Capuchino A., McConachie I. Peri-operative effect of major gastrointestinal surgery on serum magnesium. Anaesthesia. 1994;49(10):912–914. doi: 10.1111/j.1365-2044.1994.tb04275.x.
    1. Tauzin-Fin P., Sesay M., Delort-Laval S., Krol-Houdek M. C., Maurette P. Intravenous magnesium sulphate decreases postoperative tramadol requirement after radical prostatectomy. European Journal of Anaesthesiology. 2006;23(12):1055–1059. doi: 10.1017/S0265021506001062.
    1. Kara H., Sahin N., Ulusan V., Aydogdu T. Magnesium infusion reduces perioperative pain. European Journal of Anaesthesiology. 2002;19(1):52–56. doi: 10.1017/s026502150200008x.
    1. Karaaslan K., Yilmaz F., Gulcu N., Sarpkaya A., Colak C., Kocoglu H. The effects of levobupivacaine versus levobupivacaine plus magnesium infiltration on postoperative analgesia and laryngospasm in pediatric tonsillectomy patients. International Journal of Pediatric Otorhinolaryngology. 2008;72(5):675–681. doi: 10.1016/j.ijporl.2008.01.029.
    1. James M. F. M., Esser J. D., Beer R. E. Intravenous magnesium sulfate inhibits catecholamine release associated with tracheal intubation. Anesthesia and Analgesia. 1989;68(6):772–776.
    1. Kizilirmak S. Magnesium sulfate stops postanesthetic shivering. Annals of the New York Academy of Sciences. 1997;813:799–806. doi: 10.1111/j.1749-6632.1997.tb51784.x.
    1. Dabbagh A., Elyası H., Razavı S. S., Fathı M., Rajaei S. Intravenous magnesium sulfate for post-operative pain in patients undergoing lower limb orthopedic surgery. Acta Anaesthesiologica Scandinavica. 2009;53(8):1088–1091. doi: 10.1111/j.1399-6576.2009.02025.x.
    1. Arcioni R., Palmisani S., Tigano S., et al. Combined intrathecal 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 Anaesthesiologica Scandinavica. 2007;51(4):482–489. doi: 10.1111/j.1399-6576.2007.01263.x.
    1. Tauzin-Fin P., Sesay M., Svartz L., Krol-Houdek M.-C., Maurette P. Wound infiltration with magnesium sulphate and ropivacaine mixture reduces postoperative tramadol requirements after radical prostatectomy. Acta Anaesthesiologica Scandinavica. 2009;53(4):464–469. doi: 10.1111/j.1399-6576.2008.01888.x.
    1. Elsharnouby N. M., Eid H. E., Abou Elezz N. F., Moharram A. N. Intraarticular injection of magnesium sulphate and/or bupivacaine for postoperative analgesia after arthroscopic knee surgery. Anesthesia & Analgesia. 2008;106(5):1548–1552. doi: 10.1213/ane.0b013e31816a67a8.
    1. Bondok R. S., Abd El-Hady A. M. Intra-articular magnesium is effective for postoperative analgesia in arthroscopic knee surgery. British Journal of Anaesthesia. 2006;97(3):389–392. doi: 10.1093/bja/ael176.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi