الفهرس 
Management of Acute Postoperative PainOnly 14 pages are availabe for public view
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Abstract
This study was done in Ain Shams University Hospital, Faculty of Medicine, Anesthesia Department. All patients gave informed consents and the study protocol was approved by the hospital ethical committee.
The aim of this study is to evaluate the co-analgesic effect of magnesium in the postoperative setting after cardiac surgery in form of opioid-sparing effect of magnesium sulfate for postoperative pain relief after elective cardiac surgery.
Forty patients aged 18 – 60 years undergoing on-pump cardiac surgery were included in the study. Patients were evenly and randomly assigned into two groups, 20 patients each. First group (magnesium group), patients received magnesium sulfate after induction of anesthesia 50 mg/kg i.v. followed by a continuous infusion at 10 mg/kg/h for 12 h after extubation. Second group (control group), patients received saline by the same previous regimen.
Induction of anesthesia for all patients was carried out by midazolam 0.1- 0.15 mg/kg i.v, fentanyl 5 -10 µg/Kg i.v. and thiopental sodium 3 - 5 mg/kg. Endotracheal intubation was facilitated with cis-atracurium 0.15 mg /kg and the lungs ventilated with 100% oxygen. Maintenance of anesthesia was done with isoflurane inhalation 0.3 – 1.2 %, cis-atracurium 0.02 mg /kg every 30 min and fentanyl as additional doses (0.5- 1µg/Kg) given before skin incision, before sternotomy and on demand.
Patient’s monitored with 5 lead ECG, continuous invasive mean arterial blood pressure, central venous pressure, temperature, oxygen saturation and end-tidal Co2 were recorded. Arrhythmias were analyzed by type, frequency and management. Urine output was also recorded before, during and after CPB.
At the end of surgery patients were warmed to oropharyngeal temperature of 37-38°C and weaned from cardiopulmonary bypass also mechanical ventilation established with 100% oxygen then patients transferred to the intensive care unit (ICU) where patients received the first six-hourly administered paracetamol 1 g infusion and propofol infusion 1.5-3 mg/kg/hour with continuous administration of fentanyl I.V. infusion (starting dose 0.3-0.8 µg/Kg/hour) that was adjusted according to the pain evaluation and sedation score.
All intraoperative monitoring parameters were continued in the postoperative period and recorded every 30 minutes in the first four hours then every hour in the next four hours then every two hours till 24 hours postoperatively also, blood gases analysis were done every 2 hours till 12 hours after extubation.
After extubation level of consciousness was assessed using level of consciousness score (LOC) every 30 min in the first 6 hours then hourly up to 12 hours after extubation.