Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD,...

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Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof .Dr.GANESH PRABHU MD, DA ., Asst .Prof.Dr. SIVAPRASATH MD ., INSTITUTE OF ANAESTHESIOLOGY MADURAI MEDICAL COLLEGE

Transcript of Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD,...

Page 1: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

Dr. ANJU PADMALAYAN PG

CO AUTHORS:Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof .Dr.GANESH PRABHU MD, DA ., Asst .Prof.Dr. SIVAPRASATH MD ., INSTITUTE OF ANAESTHESIOLOGYMADURAI MEDICAL COLLEGE

Page 2: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

AIM.

To assess the efficacy of epidural magnesium for post operative analgesia.

Page 3: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

REFERENCES Epidural magnesium reduces postoperative

analgesic requirement. British Journal of Anaesthesia 2007 98(4):519-523

Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post-operative analgesic requirements in patients undergoing major orthopedic surgery. Acta Anaesthesiologica scandinavica vol.51 issue 4, Mar 2007

Page 4: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

Randomized double blinded study INCLUSION CRITERIA

40 Patients ASA I & IIAGE 20 -60 YearsHERNIOPLASTY

EXCLUSION CRITERIA ASA III&IV C/I for performing Regional anaesthesiaAdverse reaction to study medication

Page 5: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

MATERIALS AND METHODS .. Ethical committee approval Informed written consent

Group F – Epidural FENTANYL 2mics/ml in 10 ml NS

Group FM– Epidural FENTANYL 2mics /ml + MAGNESIUM SULPHATE 50mg in 10 ml NS

Page 6: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

CLINICAL PROTOCOL..

MONITORS: NIBP, Pulseoximetery PRE LOADING: 500 ml RL sol

Page 7: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

TECHNIQUE

Patient in Right lateral position

Under strict aseptic precaution ,

Epidural performed with 16 G tuohy needle with loss of resistance to air

Catheter threaded

Test dose given

Page 8: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

Cont..

SAB performed in a space below injecting 0.5% hyperbaric Bupivacaine,

Surgery proceeded After the completion of the surgery Pt observed in the IRCU

Page 9: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

PARAMETERS OBSERVED ..

Pulse rate Blood pressure Oxygen saturation Ventilator requirement Duration of analgesia Sedation score Visual analogue score Side effects

Page 10: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

VISUAL ANALOGUE SCORE: 0 – 10 NO PAIN

LITTLE PAINCONSIDERABLE PAINLOT OF PAINWORST PAIN

  RAMSAY SEDATION SCORE: LEVELS 1 -3 patient awake LEVEL 1-anxious and agitated or restless or both LEVEL 2-cooperative and oriented LEVEL 3-responds to commands only  LEVEL 4-6 patient asleep, responds to light glabellar tap

or loud auditory stimulus LEVEL 4 –Brisk response LEVEL 5 – Sluggish response LEVEL 6 –No response

Page 11: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

STATISTICAL TOOLS

Data analysis was done with the help of computer using Epidemiological Information Package (EPI 2008).

Kruskul Wally’s chi square was used to test the significance of relationship. A ‘p’ value less than 0.05 is taken to denote significant relationship .

Page 12: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

RESULTS ..

Two groups were comparable for their demographic data and baseline hemodynamic variable .

Page 13: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

DATA COLLECTED .

GROUP FM F ‘P’

AGE IN YRS 39.2±9.9 40.2± 8.4 0.7341Not significant

SEXMALEFEMALE

90%10%

90%10%

1.0Not significant

Page 14: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

MEAN AGE (in years)

Page 15: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

PULSE RATE

PULSE RATE

AT

FM GROUP F GROUP “p”

0 minute 87 + 9.1 86.5 + 10.5 0.9028 Not

significant

30 minutes 84.5 + 13.7 93.8 + 14.6 0.0445 Significant

60 minutes 77.9 + 11.0 101 + 16.2 0.0001 Significant

120 minutes 73.1 + 7.7 101.7 + 16.1 0.0001 Significant

180 minutes 72.8 + 7.5 101.7 + 14.2 0.0001 Significant

Page 16: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

PULSE RATE

Page 17: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

SYSTOLIC BLOOD PRESSURE

SYSTOLIC B.P.

AT

FM GROUP F GROUP “p”

0 minute 119.7 + 10.7 124.1 + 11.4 0.1967 Not significant

30 minutes 117.4 + 9.2 120.5 + 9 0.2179 Not significant

60 minutes 115.2 + 7.4 118 + 7.3 0.3584 Not significant

120 minutes 115.7 + 8.4 118.5 + 8 0.2333 Not significant

180 minutes 120.2 + 7.4 122.7 + 4.7 0.4703 Not significant

Page 18: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

SYSTOLIC BLOOD PRESSURE

Page 19: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

DIASTOLIC BLOOD PRESSURE

DIASTOLIC B.P.

AT

FM GROUP F GROUP “p”

0 minute 90 + 6.2 87.6 + 6.6 0.2872 Not significant

30 minutes 85.3 + 5.4 85.4 + 5.5 0.845 Not significant

60 minutes 85.7 + 4.9 89.3 + 5.3 0.8057 Not significant

120 minutes 86.4 + 4.9 86.6 + 5.2 0.9673 Not significant

180 minutes 86.6 + 4.4 86.5 + 5.4 0.7746 Not significant

Page 20: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

DIASTOLIC BLOOD PRESSURE

Page 21: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

OXYGEN SATURATION

VARIABLE FM GROUP F GROUP “p”

SPO2 98.4 + 0.9 98.5 + 1.1 0.6896

Not significant

Page 22: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

SPO2

Page 23: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

SEDATION SCORE

SEDATION SCORE FM GROUP F GROUP

No. % No. %

3 10 50 7 35

4 10 50 13 65

Total 20 100 20 100

Mean

S.D.

3.5

0.51

3.65

0.49

‘p’ 0.3434

Not Significant

Page 24: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

SEDATION SCORE

Page 25: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

VISUAL ANALOGUE SCORE

VAS

AT

FM GROUP F GROUP “p”

0 minute 3.1 + 1.3 2.7 + 1.0 0.3126

Not significant

30 minutes 0.15 + 0.37 0.65 + 0.49 0.0014 Significant

60 minutes 0.2 + 0.41 0.8 + 0.4 0.0013 Significant

120 minutes 2.75 + 0.96 3.4 + 0.68 0.0271 Significant

180 minutes 3.4 + 0.88 3.95 + 0.22 0.0214 Significant

Page 26: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

VISUAL ANALOGUE SCALE

Page 27: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

ONSET OF ANALGESIA

There was no significant difference in the onset of analgesia in both groups.

Page 28: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

ANALGESIA DURATION .

VARIABLE FM GROUP F GROUP “p”

Duration of

analgesia

( in minutes)

148.7 + 34.4 128.5 + 28.7 0.0295

Significant

Page 29: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

DURATION OF ANALGESIA ( in minutes)

Page 30: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

DISCUSSION . Magnesium sulphate – Non competitively

antagonizes NMDA receptor channels. Non-competitive NMDA receptor

antagonists can have an effect on pain when used alone, but it has also been shown that they can reveal the analgesic properties of opioids.

Magnesium supplement enhances the

analgesic effect of opioids

Page 31: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

NMDA RECEPTORS NMDA receptors –central nociceptive

transmission

Recent studies show NMDA receptors are also present in skin, muscles & knee jt

Mg- physiological blocker of NMDA

In inactive state NMDA receptor is blocked by centrally positioned Mg ion

Page 32: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.
Page 33: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

TO SUMMARISE . The purpose of this study is to assess the

efficacy of epidural magnesium. Study..

Postoperative analgesic duration

Group F 128.50 min , FM 148.70 min.

Group FM had prolonged duration of analgesia.

Page 34: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

TO CONCLUDE .

Magnesium when given epidurally along with opioids will increase the duration of analgesia without any side effects.

Magnesium potentiates the analgesic property of opioids and hence the quality of analgesia.

Page 35: Dr. ANJU PADMALAYAN PG CO AUTHORS: Prof.& HOD Dr.I.CHANDRASEKARAN MD, DA Prof.Dr.GANESH PRABHU MD, DA., Asst.Prof.Dr. SIVAPRASATH MD., INSTITUTE OF ANAESTHESIOLOGY.

Thank You