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EPIDURAL magnesium for post operative analgesia.

EPIDURAL magnesium for post operative analgesia. 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. Dr. ANJU PADMALAYAN PG. AIM.

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EPIDURAL magnesium for post operative analgesia.

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  1. EPIDURAL magnesium for post operative analgesia. 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 Dr. ANJU PADMALAYAN PG

  2. AIM. • To assess the efficacy of epidural magnesium for post operative analgesia.

  3. 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. ActaAnaesthesiologicascandinavica vol.51 issue 4, Mar 2007

  4. Randomized double blinded study • INCLUSION CRITERIA • 40 Patients • ASA I & II • AGE 20 -60 Years • HERNIOPLASTY • EXCLUSION CRITERIA • ASA III&IV • C/I for performing Regional anaesthesia • Adverse reaction to study medication

  5. 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

  6. CLINICAL PROTOCOL.. • MONITORS: NIBP, Pulseoximetery • PRE LOADING: 500 ml RL sol

  7. 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

  8. 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

  9. PARAMETERS OBSERVED .. • Pulse rate • Blood pressure • Oxygen saturation • Ventilator requirement • Duration of analgesia • Sedation score • Visual analogue score • Side effects

  10. 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

  11. 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 .

  12. RESULTS .. • Two groups were comparable for their demographic data and baseline hemodynamic variable .

  13. DATA COLLECTED .

  14. MEAN AGE (in years)

  15. PULSE RATE

  16. PULSE RATE

  17. SYSTOLIC BLOOD PRESSURE

  18. SYSTOLIC BLOOD PRESSURE

  19. DIASTOLIC BLOOD PRESSURE

  20. DIASTOLIC BLOOD PRESSURE

  21. OXYGEN SATURATION

  22. SPO2

  23. SEDATION SCORE

  24. SEDATION SCORE

  25. VISUAL ANALOGUE SCORE

  26. VISUAL ANALOGUE SCALE

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

  28. ANALGESIA DURATION .

  29. DURATION OF ANALGESIA ( in minutes)

  30. DISCUSSION . • Magnesium sulphate – Non competitively antagonizes NMDA receptor channels. • Non-competitive NMDA receptor antagonists can have an effecton pain when used alone, but it has also been shown that theycan reveal the analgesic properties of opioids. • Magnesium supplement enhances theanalgesic effect of opioids

  31. 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

  32. 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.

  33. 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.

  34. Thank You

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