Effects of Magnesium Sulfate on Pain, Nausea/Vomiting, and Anesthetic Consumption after Corneal Transplantation and Vitrectomy

Document Type : Original Article (s)

Authors

1 Associate Professor, Anesthesiology and Critical Care Research Center AND Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor, Anesthesiology and Critical Care Research Center AND Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Student of Medicine, Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

4 Professor, Anesthesiology and Critical Care Research Center AND Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Pain and postoperative nausea/vomiting (PONV) are of the most frequent complications after major ophthalmologic surgeries, and there is no general agreement on the effective method of controlling them. We compared the effects of magnesium sulfate on pain, nausea/vomiting, and anesthetic and analgesic requirement after corneal transplantation and vitrectomy surgeries.Methods: 110 patients undergoing corneal transplantation and vitrectomy under the same manner of general anesthesia were distributed into two equal groups. In the first group, magnesium sulfate (50 mg/kg) was administered during 10 minutes just before induction of anesthesia, and then during the surgery (15 mg/kg/hour). In the placebo group, normal saline was prescribed in the same way. Information concerning the pain (visual analog scale or VAS) and nausea/vomiting, total anesthetic and additional opioid consumption, and patients' hemodynamic status was collected and compared.Findings: The mean intensity of pain and nausea were significantly lower in magnesium sulfate group compared to placebo group in the all periods during the study (pain: 1.8 and 2.8, respectively, P = 0.020; nausea: 0.35 and 1.1, respectively, P = 0.020). But, there were no significant difference in the incidence of vomiting (P = 0.500) and total doses of ondansetrone and pethidine consumption among the two groups (P > 0.050).Conclusion: Magnesium sulfate administration is more effective than placebo to reduce anesthetic consumption, pain, and nausea/vomiting after corneal transplantation and vitrectomy.

Keywords


  1. Apfek CC. Postoperative nausea and vomiting. In: Miller RD, editor. Miller's anesthesia. Philadelphia, PA: Churchill Livingstone; 2010. p. 2729.
  2. Stoelting RK. Acute postoperative pain management. In: Miller RD, Stoelting RK, editors. Basics of anesthesia. 5th ed. Philadelphia, PA: Churchill Livingstone; 2006. p. 580-1.
  3. Rahimi M, Farsani DM, Naghibi K, Alikiaii B. Preemptive morphine suppository for postoperative pain relief after laparoscopic cholecystectomy. Adv Biomed Res 2016; 5: 57.
  4. Saryazdi H, Aghadavoudi O, Moradi D, Hamedani A. Comparison the efficacy of pre-emptive oral celecoxib with acetaminophen in controlling post-operative pain and nausea after lower limb surgery under general anesthesia. Journal of Cellular and Molecular Anesthesia 2016; 1(2): 62-8.
  5. Jabalameli M, Safavi M, Honarmand A, Saryazdi H, Moradi D, Kashefi P. The comparison of intraincisional injection tramadol, pethidine and bupivacaine on postcesarean section pain relief under spinal anesthesia. Adv Biomed Res 2012; 1: 53.
  6. Moradi D, Naghibi K, Alikiaii B, Mashayekhi Z. Comparison of the effects of intravenous phenylephrine and ephedrine in treatment of hypotension after spinal anesthesia in orthopedic surgery. J Babol Univ Med Sci 2016; 18(6): 21-7. [In Persian].
  7. Naghibi K, Moradi Farsani D, Ali Kiaei B, Hirmanpour A. Comparing the effect of intravenous and inhalational anesthtics on hemodynamic changes in deep vitrectomy surgery. J Arak Univ Med Sci 2016; 19(2): 80-8. [In Persian].
  8. Rahimi M, Montazeri K, Kamali L, Moradi M, Naghibi Kh. comparing the effects of magnesium sulfate and nitroglycerin on the control of hypertension during and after cataract surgery under local anesthesia and intravenous sedation. J Isfahan Med Sch 2016; 33(361): 2076-83. [In Persian].
  9. Moradi-Farsani D, Naghibi K, Taheri S, Ali-Kiaii B, Rahimi-Varposhti M. Effects of age and gender on acute postoperative pain after cataract surgery under topical anesthesia and sedation. J Isfahan Med Sch 2017; 34(414): 1627-33. [In Persian].
  10. Moradi-Farsani D, Akrami F, Naghibi K, Alikiaii B, Nazemorroaya B. The effect of age and sex on postoperative pain after deep vitrectomy. J Isfahan Med Sch 2017; 34(415): 1660-5. [In Persian].
  11. Nazemroaya B, Mohammadi AH, Najafian J, Moradi-Farsani D. Effect of preemptive midazolam on post-electroconvulsive-therapy (ECT) headache, myalgia, and nausea and vomiting. J Isfahan Med Sch 2017; 35(417): 26-31. [In Persian].
  12. Glick DB. Overview of complications occurring in the post-anesthesia care unit [Online]. [cited 2011 Oct 20]; Available from: URL:
  13. http://cursoenarm.net/UPTODATE/contents/mobipreview.htm?36/32/37377?source=see_link
  14. Begon S, Pickering G, Eschalier A, Mazur A, Rayssiguier Y, Dubray C. Role of spinal NMDA receptors, protein kinase C and nitric oxide synthase in the hyperalgesia induced by magnesium deficiency in rats. Br J Pharmacol 2001; 134(6): 1227-36.
  15. Saadawy IM, Kaki AM, Abd El Latif AA, Abd-Elmaksoud AM, Tolba OM. Lidocaine vs. magnesium: effect on analgesia after a laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2010; 54(5): 549-56.
  16. Oguzhan N, Gunday I, Turan A. Effect of magnesium sulfate infusion on sevoflurane consumption, hemodynamics, and perioperative opioid consumption in lumbar disc surgery. J Opioid Manag 2008; 4(2): 105-10.
  17. Ko SH, Lim HR, Kim DC, Han YJ, Choe H, Song HS. Magnesium sulfate does not reduce postoperative analgesic requirements. Anesthesiology 2001; 95(3): 640-6.
  18. Gupta SD, Mitra K, Mukherjee M, Roy S, Sarkar A, Kundu S, et al. Effect of magnesium infusion on thoracic epidural analgesia. Saudi J Anaesth 2011; 5(1): 55-61.
  19. Henzler D, Kramer R, Steinhorst UH, Piepenbrock S, Rossaint R, Kuhlen R. Factors independently associated with increased risk of pain development after ophthalmic surgery. Eur J Anaesthesiol 2004; 21(2): 101-6.
  20. Dotson R, Wiener-Kronish J, Ajaji T. Preoperative evaluation and medication. In: Miller RD, Stoelting RK, editors. Basics of anesthesia. 5th ed. Philadelphia, PA: Churchill Livingstone; 2006. p. 171.
  21. van den Berg AA, Savva D, Honjol NM. Attenuation of the haemodynamic responses to noxious stimuli in patients undergoing cataract surgery. A comparison of magnesium sulphate, esmolol, lignocaine, nitroglycerine and placebo given i.v. with induction of anaesthesia. Eur J Anaesthesiol 1997; 14(2): 134-47.
  22. Yosry M, Othman IS. Controlled hypotension in adults undergoing choroidal melanoma resection: comparison between the efficacy of nitroprusside and magnesium sulphate. Eur J Anaesthesiol 2008; 25(11): 891-6.
  23. Ray M, Bhattacharjee DP, Hajra B, Pal R, Chatterjee N. Effect of clonidine and magnesium sulphate on anaesthetic consumption, haemodynamics and postoperative recovery: A comparative study. Indian J Anaesth 2010; 54(2): 137-41.
  24. Guerrera MP, Volpe SL, Mao JJ. Therapeutic uses of magnesium. Am Fam Physician 2009; 80(2): 157-62.
  25. Aghadavoudi O, Abbasi S, Kashefi P, Golparvar M, Habibzade M, Kazemi S. Evaluation of intravenous neostigmine infusion on tolerance of enteral nutrition in Intensive Care Unit patients. J Res Med Sci 2013; 18(9): 750-4.
  26. Moradi Farsani D, Alikiaei B, Hoseinzadeh F. Comparison of Ondansetrone, Metoclopramide and Midazolam for PONV prophylaxis in Strabismus surgery. J Arak Univ Med Sci 2017; 20(2): 67-77. [In Persian].
  27. Aghadavoudi O, Amiri E. Comparison of granisetron, metoclopramide and gastric decompression for prevention of postoperative nausea and vomiting after fast track cardiac anesthesia. J Res Med Sci 2008; 13(4): 166-74.