الفهرس 
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Abstract
Objectives: This study aim to evaluate the pre-emptive antinociceptive effects of magnesium sulfate when given epidurally and to prove that the addition of magnesium sulfate to epidural bubivacaine decreases the postoperative narcotic requirements and improves the quality of analgesia.
Background: As pain is one of the most common problems challenging the anesthetist in the postoperative period, it has become common practice to use poly-pharmacological approach for the treatment of postoperative pain, because no drug has yet been identified that specifically inhibits nociception without associated side effects. Regional anesthesia is a safe, inexpensive technique, with the advantage of prolonged postoperative pain relief. Magnesium has antinociceptive effects that are primarily based on the regulation of calcium influx into the cell which is natural physiological calcium antagonist and antagonist of N-methyl- D- aspartate (NMDA) receptor. These effects prompted the use of magnesium as adjuvant for postoperative analgesia.
Patients and Methods: Our study is a randomized double blind clinical trial that studied the effect of intra-operative co-administration of epidural magnesium sulfate on postoperative pain and on postoperative narcotic requirements. The study was done on 60 patients ASA I and II.
Results: A significant difference between both groups in the number of patients who requested analgesia and did not requested analgesia postoperative, Regarding the use of pethidine as rescue analgesia, there were significant difference between both groups in the number of patients who requested analgesia (p=0.002) and in the dose given in mg (p=0.002).
Conclusion: The co-administration of epidural magnesium sulfate improves postoperative epidural analgesia when given in a dose of 50 mg bolus followed by 10mg/h infusion during surgery where there was prolongation in the first time of analgesic requirements, better visual analogue score, less requirements of rescue analgesia, and less fentanyl consumption. Also it minimized the side effects of fentanyl as drowsiness, nausea, vomiting, or pruritus, with no hemodynamic changes.
Recommendations: This study suggests that magnesium sulfate may be useful alternative as an adjuvant to opioids for better and more prolonged analgesia.