Özlem ANBARCI, ALPARSLAN APAN, Şaziye ŞAHİN

Aksiller brakiyal pleksus blokajında magnezyum infüzyonunun postoperatif analjeziye etkileri

Genel anesteziden sonra başlanan magnezyum sülfat infüzyonu analjezik gereksinimini azaltmaktadır. Bu çalışmada, brakiyal pleksus blokajından sonra postoperatif ilk 24 saat uygulanan magnezyum sülfat infüzyonunun blok süresi, sedasyon ve postoperatif analjezik tüketimine etkilerinin araştırılması amaçlandı. Yerel Etik Kurul onayı alınarak ASA I ve II sınıfı 70 hasta çift kör, randomize çalışmaya alındı. Brakiyal pleksus blokajı aksiller yaklaşımla lidokainin 40 ml %1.25 1/200000 adrenalinli solüsyonu kullanılarak gerçekleştirildi. Hastalara 24 saat sürede eşit volümde 5 mg.kg–1 bolus ve 500 mg.saat–1 magnezyum sülfat veya serum uygulandı. İlk 24 saatlik sürede grupların ilk ağrı duyumu, motor bloğun kalkma süresi ve analjezik gereksinimi yanında 4 saatte bir alınan sedasyon ve vizüel analog skorları değerlendirildi. İlk ağrı duyumu ve ilk analjezik kullanımı belirgin oranda artmakla birlikte magnezyum infüzyon grubunda toplam analjezik tüketiminde belirgin düzeyde azalma saptandı (Dolantin: K: 36.3 ± 42.6 mg, Mg: 11.7 ± 12.2 mg, p: 0.001). Aynı zamanda vizüel analog skorların tüm peryotlarda azaldığı gözlendi. Motor blok gerileme ve sedasyon skorları arasında fark bulunamadı. Magnezyum sülfat infüzyonunun, brakiyal pleksus blokajı uygulanan hastalar için analjezik tüketimini ve olası yan etkilerini günlük aktiviteleri etkilemeksizin azaltmada güvenli bir ilaç olduğu kanısına varıldı.

Anahtar Kelimeler:

Ağrı, ameliyat sonrası, Periferal sinirler, Brakial pleksus, Magnezyum sülfat, Sinir bloğu

The postoperative analgesic effects of magnesium infusion on brachial plexus block

Magnesium sulphate infusion decreases analgesic requirements after general anaesthesia. Aim of this study was to assess the effects of postoperative magnesium infusion for 24 hours on duration of the block, sedation and postoperative analgesic consumption after brachial plexus block. After obtaining approval from local ethic committee, 70 ASA class I and II patients were included to the randomised double blind study. Brachial plexus block was performed using axillary approach with lignocaine 1.25 % adrenaline 1/200 000 40 ml. Groups received 5 mg.kg –1 bolus and 500 mg.h–1 magnesium sulphate infusion or saline controls at the same volume during 24 hour. Analgesia and sedation were assessed while determining time to first pain and rescue analgesic, time to regain motor capability, visual analogue scale and sedation scores for every 4 hour during postoperative 24 h. period. While time to first pain and rescue analgesic was increased, total analgesic consumption was reduced significantly on magnesium infusion group (Meperidine: C: 36.3 ± 42.6 mg, Mg: 11.7 ± 12.2 mg, p: 0.001). Visual analogue scales were also observed to be lower in all periods. Time to motor block resolution, and sedation scores were similar. Magnesium sulphate infusion is thought as a safe and suitable adjunct for reducing analgesic consumption and possible complications without interfering daily activity in patients undergoing brachial plexus block.

Keywords:

Pain, Postoperative, Peripheral Nerves, Brachial Plexus, Magnesium Sulfate, Nerve Block,

PDF

___

Apan A, Buyukkocak U, Ozcan S ve ark.: Postoperative magnesium sulphate infusion to reduce analgesic requirements in spinal anaesthesia. Eur J Anaesthesiol 2004; 21: 766-769.
Bahar M, Chainimov M, Grinspun E ve ark.: Spinal anaesthesia induced by intrathecal magnesium sulphate. An experimental study in a rat. Anaesthesia 1996; 51: 627-633.
Bhatia A, Kashyap L, Pawar DK ve ark. Effect of intraoperative magnesium infusion on perioperative analgesia in open cholecystectomy. J Clin Anesth. 2004; 16: 262-5.
Buvanendran A, McCarthy RJ, Kroin RS ve ark.: Intrathecal magnesium prolongs fentanyl analgesia: a prospective, randomized, controlled trial. Anesth Analg 2002; 95: 661-666.
Chainimov M, Cohen ML, Grinspun Y ve ark.: Neurotoxicity after spinal anaesthesia induced by serial intrathecal injections of magnesium sulphate. Anaesthesia 1997; 52: 223-228.
Cheng JK, Lai YJ, Chen CC ve ark.: Magnesium chloride and ruthenium red attenuate the antiallodynic effect of intrathecal gabapentin in a rat model of postoperative pain. Anesthesiology 2003; 98: 1472-1479.
Fawcett WJ, Haxby EJ, Male DA. Magnesium: physiology nd pharmacology. Br J Anaesth 1999; 83: 302-320.
Feria M, Abad F, Sanchez A ve ark.: Magnesium sulfate injected subcutaneously suppresses autotomy in peripherally deafferented rats. Pain 1993; 53: 287-293.
Günüşen i, Kahraman S, Fırat V: Total abdominal histerektomi operasyonlarında preemptif MgSO4 ile remifentanilin hemodinami ve postoperative ağrı üzerine etkilerinin karşılaştırılması. Türk Anesteziyoloji ve Reanimasyon Derneği Dergisi 2005; 33: 298-306.
James MF, Beer RE, Esser JD: Intravenous magnesium sulfate inhibits cathecolamine release associated with tracheal intubation. Anesth Analg 1989; 68: 772-776.
James MF: Use of magnesium sulphate in the anaesthetic management of pheochromocytoma: a review of 17 anaesthetics. Br J Anaesth 1989; 62: 616-623.
Kara H, fiahin N, Ulusan V ve ark.: Magnesium infusion reduces perioperative pain. Eur J Anaesth 2002; 19: 52-56.
Kizilirmak S, Karakas SE, Akca O ve ark.: Magnesium sulfate stops postanesthetic shivering. Ann NY Acad Sci 1997; 813: 799-806.
Ko SH, Lim HR, Kim DC ve ark.: Magnesium sulfate does not reduce postoperative analgesic requirements. Anesthesiology 2001; 95: 640-646.
Koining H, Wallner T, Marhofer P ve ark.: Magnesium sulfate reduces intra- and postoperative analgesic requirements. Anesth Analg 1998; 87: 206-210.
Lejuste MJ: Inadvertent intrathecal administration of magnesium sulphate. South African Medical Journal 1985; 68: 367-368.
Lerman J: Sudy design in clinical research: sample size estimation and power analysis. Can J Anaesth 1996; 43: 184-191.
McCarthy RJ, Kroin JS, Tuman KJ ve ark.: Antinociceptive potentiation and attenuation of tolerance by intrathecal coinfusion of magnesium sulfate and morphine in rats. Anesth Analg 1998; 86: 830-836.
Mikkelsen S, Dirks J, Fabricius P ve ark.: Effects of intravenous magnesium on pain and secondary hyperalgesia associated with heath/capsaicin sensitization model in healthy volunteers. Br J Anaesth 2001; 86: 871-873.
Seyhan TO, Tugrul M, Sungur MO ve ark.: Effects of three different dose regimens of magnesium on propofol requirements, haemodynamic variables and postoperative pain relief in gynaecological surgery.Br J Anaesth. 2006; 96: 247-52.
Tauzin-Fin P, Sesay M, Delort-Laval S ve ark.: Intravenous magnesium sulphate decreases postoperative tramadol requirement after radical prostatectomy. Eur J Anaesthesiol. 2006; 23: 1055-9.
Telci L, Esen F, Akcora D ve ark.: Evaluation of effects of magnesium sulphate in reducing intraoperative anaesthetic requirements. Br J Anaesth 2002; 89: 594-598.
Tramér MR, Schneider J, Marti RA ve ark.: Role of magnesium sulfate in postoperative analgesia. Anesthesiology 1996; 84: 340-347.
Wilder-Smith OHG, Arendt-Nielsen L, Gäumann D ve ark.: Sensory changes and pain after abdominal hysterectomy: a comparison of anesthetic supplementation with fentanyl versus magnesium or ketamine. Anesth Analg 1998; 86: 95-101.
Woolf CJ, Thompson SW: The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain 1991; 44: 293-299.
Zarausa R, Sáez-Fernández AN, Iribarren MJ ve ark.: A comparative study with oral nifedipine, intravenous nimodipine, and magnesium sulfate in postoperative analgesia. Anesth Analg 2000; 91: 938-943.