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 ANAESTHESIOLOGY MADURAI 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 (4):  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 & II AGE 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.

DATA COLLECTED. GROUPFMF‘P’ AGE IN YRS 39.2± ± Not significant SEX MALE FEMALE 90% 10% 90% 10% 1.0 Not significant

MEAN AGE (in years)

PULSE RATE AT FM GROUPF GROUP“p” 0 minute Not significant 30 minutes Significant 60 minutes Significant 120 minutes Significant 180 minutes Significant

PULSE RATE

SYSTOLIC BLOOD PRESSURE SYSTOLIC B.P. AT FM GROUPF GROUP“p” 0 minute Not significant 30 minutes Not significant 60 minutes Not significant 120 minutes Not significant 180 minutes Not significant

SYSTOLIC BLOOD PRESSURE

DIASTOLIC BLOOD PRESSURE DIASTOLIC B.P. AT FM GROUPF GROUP“p” 0 minute Not significant 30 minutes Not significant 60 minutes Not significant 120 minutes Not significant 180 minutes Not significant

DIASTOLIC BLOOD PRESSURE

OXYGEN SATURATION VARIABLE FM GROUPF GROUP“p” SPO Not significant

SPO2

SEDATION SCORE FM GROUPF GROUP No.% % Total Mean S.D ‘p’ Not Significant

SEDATION SCORE

VISUAL ANALOGUE SCORE VAS AT FM GROUPF GROUP“p” 0 minute Not significant 30 minutes Significant 60 minutes Significant 120 minutes Significant 180 minutes Significant

VISUAL ANALOGUE SCALE

ONSET OF ANALGESIA  There was no significant difference in the onset of analgesia in both groups.

ANALGESIA DURATION. VARIABLE FM GROUPF GROUP“p” Duration of analgesia ( in minutes) 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 min, FM 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