Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD,...
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Transcript of Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD,...
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