Comparison of Analgesic Effects of Intravenous and Intraperitoneal Magnesium Sulphate in Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Study
Abstract
Background: Postsurgical pain following laparoscopic cholecystectomy is often associated with delayed recovery and discharge from the hospital. Magnesium sulphate as an adjuvant has shown a potential role as an anti-analgesic drug perioperatively. However, the data on the effectiveness and safety of magnesium sulphate delivered via two distinct routes (intravenous and intraperitoneal) for postoperative pain management is scant.
Methods: This prospective randomized controlled trial was conducted on 80 adult patients. Group A (n=40) received 30ml intravenous magnesium sulphate(50mg/kg) and 30ml 0.25% bupivacaine intraperitoneal infiltration. Group B (n=40) received 30ml intraperitoneal infiltration of magnesium sulphate(50mg/kg) along with 0.25% bupivacaine and 30ml intravenous 0.9% normal saline infusion. Postoperative pain-free duration, pain scores (visual analog score), need of rescue analgesia, intraoperative hemodynamics and postoperative complications were noted.
Results: The Visual analogue scores at 1,2,4 and 6 postoperative hours were 1.75±0.78, 1.33±0.66, 0.60±0.50, 0.45±0.55 in Group B and 2.13±0.61, 1.65±0.62, 1.28±0.88, 0.73±0.51 in Group A respectively (P-value-0.02,0.03,0.00 and 0.02). The time of the first request for rescue analgesia in Group A was 37.09± 5.54 and in Group B 52.00±4.30 (P value-0.00). Mean heart rate, systolic and diastolic blood pressure were significantly lower in Group A compared to Group B (P-value<0.05). Extubation and emergence time was significantly higher in group A compared to Group B (P-value -0.00). The Abbreviated mental test (AMT)-4 cognition scores were similar in both groups while Alert, Voice, Pain and Unresponsive (AVPU) sedation score was higher at the first postoperative hour in Group A (1.30± 0.46) compared to Group B (1.10 ± 0.30) (P value- 0.026).
Conclusion: Intraperitoneal magnesium is a safe and efficient means of controlling postoperative pain. Additionally, it decreases the time required for emergence and extubation as compared to intravenous delivery. Intravenous magnesium has better hemodynamic control in perioperative period.
[2] Layzell M. Current interventions and approaches to postoperative pain management. Br J Nurs. 2008; 17(7):414-9.
[3] Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy. Br J Surg. 2000; 87(3):273-84.
[4] Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg. 2001; 167(2):84-96.
[5] Dahl JB, Møiniche S, Kehlet H. Wound infiltration with local anaesthetics for postoperative pain relief. Acta Anaesthesiol Scand. 1994; 38(1):7-14.
[6] Soave PM, Conti G, Costa R, Arcangeli A. Magnesium and anaesthesia. Curr Drug Targets. 2009; 10(8):734-43.
[7] Tramer MR, Schneider J, Marti RA, Rifat K. Role of magnesium sulfate in postoperative analgesia. Anesthesiology: Anesthesiology. 1996; 84(2):340-7.
[8] Mentes O, Harlak A, Yigit T, BALKAN A, Balkan M, Cosar A, et al. Effect of intraoperative magnesium sulphate infusion on pain relief after laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2008; 52(10):1353-9.
[9] Hwang JY, Na HS, Jeon YT, Ro YJ, Kim CS, Do SH. IV infusion of magnesium sulphate during spinal anaesthesia improves postoperative analgesia. Br J Anaesth. 2010; 104(1):89-93.
[10] Alavi SM, Baharestani B, Farsad BF, Bakhshandeh H, Babaee T, Sdeghpur A, et al. Intraoperative magnesium sulfate can reduce narcotic requirement after coronary bypass surgery. Iranian Heart Journal. 2011;12(1):6-11.
[11] Haryalchi K, Ghanaie MM, Yaghoubi Y, Milani F, Faraji R. An assessment of changes in the magnesium level during gynecological abdominal surgeries. J basic clin reprod sci. 2013;2(2):110-4.
[12] Shah PN, Dhengle Y. Magnesium sulfate for postoperative analgesia after surgery under spinal anesthesia. Acta Anaesthesiol Taiwan. 2016; 54(2):62-4.
[13] Ali RM, Rabie AH, Elshalakany NA, El Gindy TM. Effect of intraperitoneal magnesium sulfate on hemodynamic changes and its analgesic and antiemetic effect in laparoscopic cholecystectomy. Ain-Shams J Anaesthesiol. 2015; 8(2):153-9.
[14] Lujan JA, Parrilla P, Robles R, Marin P, Torralba JA, Garcia-Ayllon J. Laparoscopic cholecystectomy vs open cholecystectomy in the treatment of acute cholecystitis: a prospective study. Arch Surg. 1998; 133(2):173-5.
[15] Ekstein P, Szold A, Sagie B, Werbin N, Klausner JM, Weinbroum AA. Laparoscopic surgery may be associated with severe pain and high analgesia requirements in the immediate postoperative period. Ann Surg. 2006; 243(1):41-6.
[16] Maharjan SK, Shrestha S. Intraperitoneal magnesium sulphate plus bupivacaine for pain relief after laparoscopic cholecystectomy. J Kathmandu Med Coll. 2012; 1(1):21-5.
[17] Jee D, Lee D, Yun S, Lee C. Magnesium sulphate attenuates arterial pressure increase during laparoscopic cholecystectomy. Br J Anaesth. 2009; 103(4):484-9.
[18] Dar SA, Gupta DD, Deopujari RC, Gomes P. Effect of magnesium sulphate on attenuation of hemodynamic stress responses during laparoscopic abdominal surgeries. J Anesth Clin Res. 2015; 6(590):2.
[19] Paul S, Biswas P, Bhattacharjee DP, Sengupta J. Effects of magnesium sulfate on hemodynamic response to carbon dioxide pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. Anesth Essays Res. 2013; 7(2):228.
[20] Czarnetzki C, Lysakowski C, Elia N, Tramer MR. Time course of rocuronium‐induced neuromuscular block after pre‐treatment with magnesium sulphate: a randomised study. Acta Anaesthesiol Scand. 2010; 54(3):299-306.
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| Issue | Vol 8 No 4 (2022): Autumn |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v8i4.10179 | |
| Keywords | ||
| Analgesia Intravenous Intraperitoneal Laparoscopic cholecystectomy Magnesium Sulphate | ||
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