scholarly journals Application of magnesium sulphate as a " multimodal general anesthesia" protocol in patients undergoing hysteroscopy: a randomized controlled study

2020 ◽  
Author(s):  
Peng-fei Gao ◽  
Jing-yan Lin ◽  
Shun Wang ◽  
Yun-feng Zhang ◽  
Guo-qiang Wang ◽  
...  

Abstract Background The purpose of the study was to applicate magnesium sulphate as a " multimodal general anesthesia" protocol to reduce perioperative opioids requirements in patients undergoing hysteroscopy. Methods 70 patients scheduled for hysteroscopy were randomly divided into 2 groups. Patients in the Group M received intravenous magnesium sulfate 50 mg/kg in 100 ml of isotonic saline over 15 min before propofol injection and then 15 mg/kg per hour by continuous intravenous infusion. Patients in the control group received an equal volume of normal saline as placebo. All patients were anesthetized under a BIS guided monitored anesthesia care with propofol and fentanyl. Intraoperative anesthetic agent requirements and hemodynamic variables were recorded. Postoperative pain score was assessed with verbal numerical rating scale (VNRS) 1 min, 15 min, 30 min, 1 hour and 4 hours after recovery of consciousness. Results Postoperative serum magnesium concentrations in Group C were significantly declined than preoperative levels (0.86 ± 0.06 to 0.80 ± 0.08 mmol/L, P=0.001) while there was no statistical change in Group M (0.86 ± 0.07 to 0.89 ± 0.07 mmol/L, P=0.129). The total dose of fentanyl given to patients in Group M was less than the one administered to Group C (100 (75-150) vs 145 (75-175) μg, median (range); P < 0.001). Fewer patients in Group M required additional analgesic postoperatively. In addition, patients receiving magnesium displayed less VNRS scores at 15 min, 30 min, 1 hour and 4 hours postoperatively. Conclusions Intravenous infusion of magnesium sulphate significantly reduces perioperative opioids requirements. Meanwhile, it was beneficial to reduce postoperative pain and maintain stable of serum magnesium concentration after the procedure.

2020 ◽  
Author(s):  
Peng-fei Gao ◽  
Jing-yan Lin ◽  
Shun Wang ◽  
Yun-feng Zhang ◽  
Guo-qiang Wang ◽  
...  

Abstract Background: The purpose of the study was to applicate magnesium sulphate as a " multimodal general anesthesia" protocol to reduce perioperative opioids requirements in patients undergoing hysteroscopy.Methods: 70 patients scheduled for hysteroscopy were randomly divided into 2 groups. Patients in Group M received intravenous magnesium sulfate 50 mg/kg in 100 ml of isotonic saline over 15 min before fentanyl injection and then 15 mg/kg per hour by continuous intravenous infusion. Patients in the control group received an equal volume of normal saline as placebo. All patients were anesthetized under a BIS guided monitored anesthesia care with propofol and fentanyl. Intraoperative hemodynamic variables were recorded and postoperative pain scores were assessed with verbal numerical rating scale (VNRS) 1 min, 15 min, 30 min, 1 hour, and 4 hours after recovery of consciousness. The primary outcome of our study was total amount of intraoperative and postoperative analgesics administered.Results: Postoperative serum magnesium concentrations in Group C were significantly decreased than preoperative levels (0.86 ± 0.06 to 0.80 ± 0.08 mmol/L, P=0.001) while there was no statistical change in Group M (0.86 ± 0.07 to 0.89 ± 0.07 mmol/L, P=0.129). Bradycardia did not occur in either group and the incidence of hypotension was comparable between the two groups. Total dose of fentanyl given to patients in Group M was less than the one administered to Group C [100 (75-150) vs 145 (75-175) μg, median (range); P < 0.001]. Fewer patients in Group M required additional analgesics postoperatively. In addition, patients receiving magnesium displayed lower VNRS scores at 15 min, 30 min, 1 hour, and 4 hours postoperatively. Conclusions: Intravenous infusion of magnesium sulphate significantly reduces postoperative pain and perioperative opioid requirements without increasing the risk of cardiovascular side effects. Meanwhile, it was beneficial to maintain a stable serum magnesium concentration after the procedure.Trial registration: www.chictr.org.cn ChiCTR1900024596 date of registration: July 18th 2019.


2020 ◽  
Author(s):  
Peng-fei Gao ◽  
Jing-yan Lin ◽  
Shun Wang ◽  
Yun-feng Zhang ◽  
Guo-qiang Wang ◽  
...  

Abstract Background: Opioids are the most effective antinociceptive agents, they have undesirable side effects such as respiratory depressant and postoperative nausea and vomiting. The purpose of the study was to evaluate the antinociceptive efficacy of adjuvant magnesium sulphate to reduce intraoperative and postoperative opioids requirements and their related side effects during hysteroscopy.Methods: 70 patients scheduled for hysteroscopy were randomly divided into 2 groups. Patients in the magnesium group (Group M) received intravenous magnesium sulfate 50 mg/kg in 100 ml of isotonic saline over 15 min before anesthesia induction and then 15 mg/kg per hour by continuous intravenous infusion. Patients in the control group (Group C) received an equal volume of isotonic saline as placebo. All patients were anesthetized under a BIS guided monitored anesthesia care with propofol and fentanyl. Intraoperative hemodynamic variables were recorded and postoperative pain scores were assessed with verbal numerical rating scale (VNRS) 1 min, 15 min, 30 min, 1 hour, and 4 hours after recovery of consciousness. The primary outcome of our study was total amount of intraoperative and postoperative analgesics administered.Results: Postoperative serum magnesium concentrations in Group C were significantly decreased than preoperative levels (0.86 ± 0.06 to 0.80 ± 0.08 mmol/L, P=0.001) while there was no statistical change in Group M (0.86 ± 0.07 to 0.89 ± 0.07 mmol/L, P=0.129). Bradycardia did not occur in either group and the incidence of hypotension was comparable between the two groups. Total dose of fentanyl given to patients in Group M was less than the one administered to Group C [100 (75-150) vs 145 (75-175) μg, median (range); P < 0.001]. In addition, patients receiving magnesium displayed lower VNRS scores at 15 min, 30 min, 1 hour, and 4 hours postoperatively.Conclusions: In hysteroscopy, adjuvant magnesium administration is beneficial to reduce intraoperative fentanyl requirement and postoperative pain without cardiovascular side effects. Our study indicates that if surgical patients have risk factors for hypomagnesemia, assessing and correcting magnesium level will be necessary.Trial registration: www.chictr.org.cn ChiCTR1900024596. date of registration: July 18th 2019.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Peng-fei Gao ◽  
Jing-yan Lin ◽  
Shun Wang ◽  
Yun-feng Zhang ◽  
Guo-qiang Wang ◽  
...  

Abstract Background Opioids are the most effective antinociceptive agents, they have undesirable side effects such as respiratory depressant and postoperative nausea and vomiting. The purpose of the study was to evaluate the antinociceptive efficacy of adjuvant magnesium sulphate to reduce intraoperative and postoperative opioids requirements and their related side effects during hysteroscopy. Methods Seventy patients scheduled for hysteroscopy were randomly divided into 2 groups. Patients in the magnesium group (Group M) received intravenous magnesium sulfate 50 mg/kg in 100 ml of isotonic saline over 15 min before anesthesia induction and then 15 mg/kg per hour by continuous intravenous infusion. Patients in the control group (Group C) received an equal volume of isotonic saline as placebo. All patients were anesthetized under a BIS guided monitored anesthesia care with propofol and fentanyl. Intraoperative hemodynamic variables were recorded and postoperative pain scores were assessed with verbal numerical rating scale (VNRS) 1 min, 15 min, 30 min, 1 h, and 4 h after recovery of consciousness. The primary outcome of our study was total amount of intraoperative and postoperative analgesics administered. Results Postoperative serum magnesium concentrations in Group C were significantly decreased than preoperative levels (0.86 ± 0.06 to 0.80 ± 0.08 mmol/L, P = 0.001) while there was no statistical change in Group M (0.86 ± 0.07 to 0.89 ± 0.07 mmol/L, P = 0.129). Bradycardia did not occur in either group and the incidence of hypotension was comparable between the two groups. Total dose of fentanyl given to patients in Group M was less than the one administered to Group C [100 (75–150) vs 145 (75–175) μg, median (range); P < 0.001]. In addition, patients receiving magnesium displayed lower VNRS scores at 15 min, 30 min, 1 h, and 4 h postoperatively. Conclusions In hysteroscopy, adjuvant magnesium administration is beneficial to reduce intraoperative fentanyl requirement and postoperative pain without cardiovascular side effects. Our study indicates that if surgical patients have risk factors for hypomagnesemia, assessing and correcting magnesium level will be necessary. Trial registration ChiCTR1900024596. date of registration: July 18th 2019.


2020 ◽  
Author(s):  
Peng-fei Gao ◽  
Jing-yan Lin ◽  
Shun Wang ◽  
Yun-feng Zhang ◽  
Guo-qiang Wang ◽  
...  

Abstract Background: Opioids are the most effective antinociceptive agents, they have undesirable side effects such as respiratory depressant and postoperative nausea and vomiting. The purpose of the study was to evaluate the antinociceptive efficacy of adjuvant magnesium sulphate to reduce intraoperative and postoperative opioids requirements and their related side effects during hysteroscopy.Methods: 70 patients scheduled for hysteroscopy were randomly divided into 2 groups. Patients in the magnesium group (Group M) received intravenous magnesium sulfate 50 mg/kg in 100 ml of isotonic saline over 15 min before anesthesia induction and then 15 mg/kg per hour by continuous intravenous infusion. Patients in the control group (Group C) received an equal volume of isotonic saline as placebo. All patients were anesthetized under a BIS guided monitored anesthesia care with propofol and fentanyl. Intraoperative hemodynamic variables were recorded and postoperative pain scores were assessed with verbal numerical rating scale (VNRS) 1 min, 15 min, 30 min, 1 hour, and 4 hours after recovery of consciousness. The primary outcome of our study was total amount of intraoperative and postoperative analgesics administered.Results: Postoperative serum magnesium concentrations in Group C were significantly decreased than preoperative levels (0.86 ± 0.06 to 0.80 ± 0.08 mmol/L, P=0.001) while there was no statistical change in Group M (0.86 ± 0.07 to 0.89 ± 0.07 mmol/L, P=0.129). Bradycardia did not occur in either group and the incidence of hypotension was comparable between the two groups. Total dose of fentanyl given to patients in Group M was less than the one administered to Group C [100 (75-150) vs 145 (75-175) μg, median (range); P < 0.001]. Fewer patients in Group M required additional analgesics postoperatively [14 vs 6 subjects in Group C and Group M, RR=0.44 (0.19 to 1.01), p=0.040, NNT 4.349]. In addition, patients receiving magnesium displayed lower VNRS scores at 15 min, 30 min, 1 hour, and 4 hours postoperatively. Conclusions: In hysteroscopy, adjuvant magnesium administration is beneficial to reduce postoperative pain and perioperative opioids requirements without cardiovascular side effects. Our study indicates that if surgical patients have risk factors for hypomagnesemia, assessing and correcting magnesium level will be necessary.Trial registration: www.chictr.org.cn ChiCTR1900024596 date of registration: July 18th 2019.


2020 ◽  
Author(s):  
Hong Chen ◽  
Bin Wang ◽  
Qin Li ◽  
Juan Zhou ◽  
Rui Li ◽  
...  

Abstract Background: The catheter-related bladder discomfort (CRBD) of male patients is a common clinical problem, albeit lacking effective solutions. The present study aimed to investigate whether intravesical dexmedetomidine instillation alleviates the postoperative urinary discomfort in male patients with catheter under general anesthesia.Methods: This single-blinded, prospective, randomized study included a total of 167 male patients American Society of Anesthesiologists (ASA) physical status I-II scheduled for surgery under general anesthesia were allocated to two groups: 84 in the dexmedetomidine group and 83 in the control group. Dexmedetomidine group patients received intravesical instillation of the drug 0.5 μg/kg and normal saline 20 mL, while the control group received intravesical instillation of 20 mL normal saline. The catheter was clamped for 30 min after intravesical instillation for all patients. CRBD scores and urethra pain numerical rating scale (NRS) scores were measured at admittance to post-anesthesia care unit (PACU) (T0), intravesical instillation (T1), 30 min (T2), 60 min (T3), 2 h (T4) after intravesical instillation, discharged from PACU (T5), and 6 h (T6) and 24 h (T7) after the operation. Patient satisfaction at discharge from PACU and 24 h post-operation were compared between the two groups. Results: CRBD scores and urethra pain NRS scores after 30 min of intravesical dexmedetomidine instillation to 24 h post-operation were significantly lower than the control group (p<0.001), and patient satisfaction was higher at discharge from PACU and 24 h post-operation (p<0.001). No differences were detected in Steward score out of PACU (p=0.213) and from the time of the end of operation to fully awake (p=0.417).Conclusion: Intravesical dexmedetomidine instillation reduces postoperative urinary discomfort and urethra pain and improves satisfaction in male patients under general anesthesia.Clinical Trial Registration: Chinese Clinical Trial Registry (No. ChiCTR1800016429), date of registration 1st June 2018


2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Arman Taheri ◽  
Katayoun Haryalchi ◽  
Mandana Mansour Ghanaie ◽  
Neda Habibi Arejan

Background and Aim. Aparallel, randomized, double blinded, placebo-controlled trial study was designed to assess the efficacy of single low dose of intravenous magnesium sulfate on post-total abdominal hysterectomy (TAH) pain relief under balanced general anesthesia.Subject and Methods. Forty women undergoing TAH surgery were assigned to two magnesium sulfate (N=20) and normal saline (N=20) groups randomly. The magnesium group received magnesium sulfate 50 mg·kg−1in 100 mL of normal saline solution i.v as single-dose, just 15 minutes before induction of anesthesia whereas patients in control group received 100 mL of 0.9% sodium chloride solution at the same time. The same balanced general anesthesia was induced for two groups. Pethidine consumption was recorded over 24 hours precisely as postoperative analgesic. Pain score was evaluated with Numeric Rating Scale (NRS) at 0, 6, 12, and 24 hours after the surgeries.Results. Postoperative pain score was lower in magnesium group at 6, 12, and 24 hours after the operations significantly (P<0.05).Pethidinerequirement was significantly lower in magnesium group throughout 24 hours after the surgeries (P=0.0001).Conclusion. Single dose of magnesium sulfate during balanced general anesthesia could be considered as effective and safe method to reduce postoperative pain and opioid consumption after TAH.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hong Chen ◽  
Bin Wang ◽  
Qin Li ◽  
Juan Zhou ◽  
Rui Li ◽  
...  

Abstract Background The catheter-related bladder discomfort (CRBD) of male patients is a common clinical problem, albeit lacking effective solutions. The present study aimed to investigate whether intravesical dexmedetomidine instillation alleviates the postoperative urinary discomfort in male patients with catheter under general anesthesia. Methods This single-blinded, prospective, randomized study included a total of 167 male patients American Society of Anesthesiologists (ASA) physical status I-II scheduled for surgery under general anesthesia were allocated to two groups: 84 in the dexmedetomidine group and 83 in the control group. Dexmedetomidine group patients received intravesical instillation of the drug 0.5 μg/kg and normal saline 20 mL, while the control group received intravesical instillation of 20 mL normal saline. The catheter was clamped for 30 min after intravesical instillation for all patients. CRBD scores and urethra pain numerical rating scale (NRS) scores were measured at admittance to post-anesthesia care unit (PACU) (T0), intravesical instillation (T1), 30 min (T2), 60 min (T3), 2 h (T4) after intravesical instillation, discharged from PACU (T5), and 6 h (T6) and 24 h (T7) after the operation. Patient satisfaction at discharge from PACU and 24 h post-operation were compared between the two groups. Results CRBD scores and urethra pain NRS scores after 30 min of intravesical dexmedetomidine instillation to 24 h post-operation were significantly lower than the control group (p < 0.001), and patient satisfaction was higher at discharge from PACU and 24 h post-operation (p < 0.001). No differences were detected in Steward score out of PACU (p = 0.213) and from the time of the end of operation to fully awake (p = 0.417). Conclusion Intravesical dexmedetomidine instillation reduces postoperative urinary discomfort and urethra pain and improves satisfaction in male patients under general anesthesia. Trial registration Chinese Clinical Trial Registry (No. ChiCTR1800016429), date of registration 1st June 2018.


2001 ◽  
Vol 95 (3) ◽  
pp. 640-646 ◽  
Author(s):  
Seong-Hoon Ko ◽  
Hye-Rin Lim ◽  
Dong-Chan Kim ◽  
Young-Jin Han ◽  
Huhn Choe ◽  
...  

Background Because magnesium blocks the N-methyl-D-aspartate receptor and its associated ion channels, it can prevent central sensitization caused by peripheral nociceptive stimulation. However, transport of magnesium from blood to cerebrospinal fluid (CSF) across the blood-brain barrier is limited in normal humans. The current study was designed to evaluate whether perioperative intravenous magnesium sulfate infusion affects postoperative pain. Methods Sixty patients undergoing abdominal hysterectomy received 50 mg/kg intravenous magnesium sulfate as a bolus dose followed by a continuous infusion of 15 mg x kg(-1) x h(-1) for 6 h (magnesium group) or the same volume of isotonic saline (control group). At the end of surgery, serum and CSF magnesium concentration were measured in both groups. The cumulative postoperative analgesic consumption was measured to assess the analgesic effect using a patient-controlled epidural analgesia device. Pain intensities at rest and during forced expiration were evaluated at 6, 24, 48, and 72 h postoperatively. Results At the end of surgery, patients in the magnesium group had significantly greater postoperative serum magnesium concentrations compared with both preoperative and control group values (P &lt; 0.001). Despite significantly higher serum magnesium concentrations in the magnesium group, there was no significant difference in magnesium concentration measured in postoperative CSF. Cumulative postoperative analgesic doses were similar in both groups. However, there was observed an inverse relation between cumulative postoperative analgesic consumption and the CSF magnesium concentration in both groups. Visual analog pain scores at rest and during forced expiration were similar and less than 4 in both groups. Conclusions Perioperative intravenous administration of magnesium sulfate did not increase CSF magnesium concentration and had no effects on postoperative pain. However, an inverse relation between cumulative postoperative analgesic consumption and the CSF magnesium concentration was observed. These results suggest that perioperative intravenous magnesium infusion may not be useful for preventing postoperative pain.


2020 ◽  
Author(s):  
Hong Chen ◽  
Bin Wang ◽  
Qin Li ◽  
Juan Zhou ◽  
Rui Li ◽  
...  

Abstract Background: The catheter-related bladder discomfort (CRBD) of male patients is a common clinical problem, albeit lacking effective solutions. The present study aimed to investigate whether intravesical dexmedetomidine instillation alleviates the postoperative urinary discomfort in male patients with catheter under general anesthesia. Methods: This single-blinded, prospective, randomized study included a total of 167 male patients American Society of Anesthesiologists (ASA) physical status I-II scheduled for surgery under general anesthesia were allocated to two groups: 84 in the dexmedetomidine group and 83 in the control group. Dexmedetomidine group patients received intravesical instillation of the drug 0.5 μg/kg and normal saline 20 mL, while the control group received intravesical instillation of 20 mL normal saline. The catheter was clamped for 30 min after intravesical instillation for all patients. Bladder stimulation scales and urethra pain numerical rating scale (NRS) scores were measured at admittance to post-anesthesia care unit (PACU) (T0), intravesical instillation (T1), 30 min (T2), 60 min (T3), 2 h (T4) after intravesical instillation, discharged from PACU (T5), and 6 h (T6) and 24 h (T7) after the operation. Patient satisfaction at discharge from PACU and 24 h post-operation were compared between the two groups. Results: Bladder stimulation scales and urethra pain NRS scores after 30 min of intravesical dexmedetomidine instillation to 24 h post-operation were significantly lower than the control group (p<0.001), and patient satisfaction was higher at discharge from PACU and 24 h post-operation (p<0.001). No differences were detected in Steward score out of PACU (p=0.213) and from the time of the end of operation to fully awake (p=0.417). Conclusion: Intravesical dexmedetomidine instillation reduces postoperative urinary discomfort and urethra pain and improves satisfaction in male patients under general anesthesia.


2015 ◽  
Vol 4 (3) ◽  
pp. 367-369
Author(s):  
Ibrahim Dughaim Alreshidi ◽  
Yu Feng ◽  
Xie Han

Aim of the present study was to evaluate the effect of flurbiprofen, which is a member of non-steroidal anti-inflammatory drug group (NSAIDs), on postoperative pain treatment. From September 2013 to May 2014, total of 250 patients were surveyed to perform a systematic evaluation of postoperative pain by comparing flurbiprofen with two other kinds of NSAIDs (diclofenac and ketorolac) and isotonic saline in a double-blind, randomized, placebo-controlled study. Patients were randomized for treatment: 65 cases received flurbiprofen, 60 cases received diclofenac sodium, 60 cases received ketorolac and 65 cases received the placebo (0.9% isotonic saline) (control group). After 24-hours of surgery patients treated with flurbiprofen, ketorolac, and diclofenac showed the lowermost PPI scores compared with those treated with 0.9% isotonic saline (P<0.05). Moreover, flurbiprofen-treated patients also had the lowest PRI(R)T scores (P<0.05). When the pain rating index was examined by subclass, a significantly lower PRI(R)S score was detected in the flurbiprofen group at 24 hours (P<0.05). However, at the 96-hour time point, no differences that were found in PPI and PRI[R] scores between the ketorolac, diclofenac, and flurbiprofen groups, whereas the control group was significantly less effective than the NSAID drugs. Flurbiprofen seemed to be the most effective NSAID for the treatment of pain after internal fixation of fracture, even though at 24 hours after surgery pain was at a maximum.DOI: http://dx.doi.org/10.3329/icpj.v4i3.21935 International Current Pharmaceutical Journal, February 2015, 4(3): 367-369 


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