Evaluation of effect of intravenous Magnesium Sulfate infusion on tourniquet induced hypertension and pain in arthroscopic knee surgery patients under epidural anesthesia

Abstract

postoperative analgesia compared to control group (p < 0.001). Postoperative serum magnesium was significantly higher in Mg group at 6 h postoperative (p < 0.001). Conclusion:In patients undergoing arthroscopic knee surgery under epidural anesthesia, IV magnesium sulfate in a dose of 30 mg/kg, followed by 10 mg/kg/h infused before tourniquet inflation could reduce TIH, and tourniquet pain with reduction in intraoperative IV fentanyl and postoperative pethidine requirements.

The use of intravenous magnesium sulfate on postoperative analgesia in orthopedic surgery

“…Among these studies, types of orthopedic surgeries included arthroscopic knee surgery (3 trials [10,25,26] ), total knee arthroplasty (1 trial [27] ), total hip arthroplasty (1 trial [15] ), lower extremity osteotomy (1 trial [16] ), posterior spinal fusion surgery (1 trial [17] ), lumbar disc surgery (1 trial [11] ), laminectomy (1 trial [28] ), lumbar arthrodesis (1 trial [29] ), and lower extremity surgery (1 trial [30] ). General anesthesia (8 trials) was used in most of the trials, [10,11,16,17,25,28–30] spinal anesthesia was used in 2 trials, [15,27] and epidural anesthesia was used in 1 trial.…”

“…General anesthesia (8 trials) was used in most of the trials, [10,11,16,17,25,28–30] spinal anesthesia was used in 2 trials, [15,27] and epidural anesthesia was used in 1 trial. [26] MgSO 4 was administered intravenously in all the trials, as a single bolus in 2 trials, [25,29] an infusion in 2 trials, [11,30] and as a bolus followed by an infusion in 7 trials. [10,15–17,26–28] Adverse effects were reported in 6 trials, [11,17,25,26,29,30] including vomiting, nausea, shivering, burning sensations, and flushing.…”

“…[26] MgSO 4 was administered intravenously in all the trials, as a single bolus in 2 trials, [25,29] an infusion in 2 trials, [11,30] and as a bolus followed by an infusion in 7 trials. [10,15–17,26–28] Adverse effects were reported in 6 trials, [11,17,25,26,29,30] including vomiting, nausea, shivering, burning sensations, and flushing.…”

“…Within all the 1s trials, 6 trials (55%) [15,16,25,26,29,30] revealed a significant decrease ( P <.05) in postoperative pain in patients treated with MgSO 4 compared with control group (Table 1). The mean pain intensity scores decreased by 53% (median, 47%) in 24 hours in 3 studies, [15,25,26] by 55%, [15,26] 41%, [25,30] and 45% [26,30] in 4, 6 and 12 hours, respectively. In 2 studies, [26,30] pain intensity scores were decreased by 56%, 52%, 52%, and 45% in 1, 2, 3, and 8 hours, respectively.…”

Magnesium Sulfate Combined with a Levobupivacaine Periarticular Cocktail for Analgesia in the Early Postoperative Period after Total Knee Arthroplasty

“…Magnesium sulfate plays an important role in the fields of anesthesia and analgesia. 12 Magnesium sulfate significantly lengthens the time of levobupivacaine nerve block and enhances the analgesic effect of levobupivacaine for the following potential reasons: (1) Mg 2þ blocks Ca 2þ influx and increases the activation threshold of nerve fiber membrane potentials, thereby enhancing the effect of nerve block with levobupivacaine and prolongating the duration of nerve block; (2) Mg 2þ can enhance the analgesic effect of opioids; (3) Mg 2þ can effectively block the activation of peripheral NMDA receptors, reduce the sensitivity of periph-eral effector receptors, and reduce the transmission of peripheral stimulus signals to the central nervous system 13 ; and (4) magnesium sulfate can promote the release of nitric oxide by vascular endothelial cells and protect the vascular endothelial dysfunction caused by ischemia reperfusion to alleviate pain. 14 This study aimed to explore the effective analgesic measures after TKA, and to evaluate the analgesic effect of magnesium sulfate combined with a levobupivacaine periarticular cocktail in the early postoperative period after TKA.…”