COMPARISON OF EPIDURAL BUPIVACAINE AND BUPIVACAINE-MAGNESIUM SULPHATE COMBINATION IN LOWER ABDOMINAL SURGERIES
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 69
Abstract
BACKGROUND The epidural technique became popular as it has some specific advantages over spinal anaesthesia. The feasibility of extended duration and differential blockade extended its application into other fields like post-operative analgesia, chronic pain relief and obstetric pain relief. But some inherent negative points of epidural technique like delayed onset and patchy analgesia persist. Various attempts have been made to rectify these negative points. Analgesic effects of magnesium sulphate on peripheral nerves may be due to the antagonism of NMDA receptors, thus preventing central sensitisation from peripheral nociceptive stimulation. Also, magnesium competitively blocks calcium influx into presynaptic endings leading to reduced acetylcholine release. The aim of the study is to add magnesium sulphate as an adjunct to epidural Bupivacaine and evaluate the impact of magnesium sulphate on the quality of the block using the following parameters; Onset of sensory blockade, Motor blockade quality, two segment regression time, Post-operative analgesia and Impact of magnesium sulphate on haemodynamic changes. MATERIALS AND METHODS We conducted a double blinded randomised controlled study in 100 patients belonging to ASA I and II undergoing elective lower abdominal surgeries to evaluate the effect of adding magnesium sulphate to Bupivacaine alone in epidural anaesthesia in KAPV Govt. Medical College Hospital. For the same reason, we divided randomly the patients into two groups of 50 each. Group C received 19 mL of 0.5% of Bupivacaine (95 mg) and 1 mL of normal saline. Group S received 19 mL of 0.5% of Bupivacaine (95 mg) and 1 mL of magnesium sulphate (50 mg). The total volume of the injected solution was 20 mL in both groups. RESULTS We found the onset of sensory blockade was faster in the magnesium group (p value <0.0001). The duration of post-operative analgesia was slightly prolonged in the study group (p value 0.41). The incidence of side effects was similar in both the groups. CONCLUSION In our study, we found the onset of sensory blockade was faster in the magnesium group. The duration of post-operative analgesia was slightly prolonged in the study group. This study concludes that epidural magnesium sulphate when added to Bupivacaine will shorten the onset of sensory blockade significantly in patients undergoing elective lower abdominal surgeries without increasing the incidence of side effects.
Authors and Affiliations
Pichai Lenin, Pachaimuthu Elango, Gurusamy Sivakumar, Anbu Srinivasan
Keywords
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- EP ID EP233242
- DOI 10.14260/Jemds/2017/1068
- Views 91
- Downloads 0
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