A CLINICAL STUDY FOR COMPARISON OF MAGNESIUM SULPHATE AND DEXMEDETOMIDINE AS COMPONENTS OF OPIOID FREE MULTIMODAL ANALGESIA REGIMEN IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY UNDER GENERAL ANAESTHESIA.
Main Article Content
Keywords
Dexmedetomidine, Magnesium sulphate, pre-emptive analgesia, multimodal analgesia.
Abstract
Introduction: Opioids are established drugs used for alleviating pain in surgeries, but they have multiple side effects. Dexmedetomidine and magnesium sulphate are being used as alternatives to overcome opioid related side effects. Objectives: To compare the duration of analgesia post-operatively in terms of time to first rescue analgesia. To estimate the total number of doses of injection Tramadol required in 24 hours postoperatively. To compare intraoperative hemodynamic stability in terms of change in HR and MAP post intubation, incision, and after creation of pneumoperitoneum. Methods: After IEC clearance, patients undergoing laparoscopic cholecystectomy were allocated to groups D and M (38 each). Group D was given Inj. Dexmedetomidine 1 mcg/kg as a bolus followed by 0.5 mcg/kg/hr as maintenance. Group M was given Inj. Magnesium sulphate 50 mg/kg as a bolus followed by 15 mg/kg/hr as maintenance. In both groups, Inj. Diclofenac 75mg and Inj. Nefopam 20 mg was given pre-emptively before induction as part of multimodal analgesia. Heart rate and mean arterial pressure were recorded at fixed intervals. Inj. Paracetamol 1gm was given as 1st rescue analgesia and Inj. Tramadol was given if the patient had persistent pain even after giving paracetamol. Time to demand rescue analgesia and the total number of tramadol doses required during 24 hours were recorded at VAS score >/= 4. Results: Results demonstrated that dexmedetomidine provided better hemodynamic stability with longer postoperative analgesia compared to magnesium sulphate. The total number of Tramadol doses required in the Dexmedetomidine group was less compared to the Magnesium sulphate group. Conclusion: Both magnesium sulphate and dexmedetomidine have good peri-operative analgesic effects with increased time to rescue analgesia and decreased opioid consumption with good hemodynamic stability peri-operatively. Hence, it can be used as an alternative to opioids in perioperative pain management.
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Prabhakar Kumar
Junior resident, Department of Anaesthesiology, T.S.Misra Medical College and Hospital, Lucknow.
Prakriti Shukla
Assistant Professor, Department of Anaesthesiology and Critical care, Dr. RMLIMS, Lucknow.
Neha Sharma
Associate Professor, Department of Anaesthesiology and Critical care, Dr. RMLIMS, Lucknow.
Anurag Srivastava
Associate Professor, Department of Anaesthesiology and Critical care, Dr. RMLIMS, Lucknow.
Supriya K
Asisstant professor, Department of Anaesthesiology Tata memorial centre, Mumbai.
P.K. Bhamri
Professor, Department of Anaesthesiology, T.S.Misra Medical College and Hospital, Lucknow
