The Effect of Adding Magnesium Sulphate to Epidural Bupivacaine Compared to the Addition of Fentanyl to Epidural Bupivacaine in Patients Undergoing Lower Limb and Pelvic Orthopedic Surgery under Combined Spinal Epidural Anesthesia

Abstract

Abstract Background Epidural anesthesia is safe and inexpensive technique with the advantage of providing surgical anesthesia and prolonged postoperative pain relief. Research continues concerning different techniques and drugs that could provide better surgical anesthesia and postoperative pain relief. Aim of the Work to investigate how the addition of magnesium sulphate to 0.5% bupivacaine affects duration, quality, complications and dermatome spread of anesthesia in comparison to fentanyl. Patients and Methods The current study included 50 patients who had been scheduled to undergo lower limb or pelvic orthopedic surgery under combined spinal - epidural anesthesia. The study had been done after approval of the local ethics committee and after obtaining written informed consent from all patients enrolled in the study; which had been held at Ain Shams Hospital, Faculty of Medicine. Results Pain assessment using VAS showed no statistically significant difference between the two studied groups in the first and second hours postoperative. Starting from the third hour statistical significant differences were observed between the two groups, VAS was higher in groups (M) than in group (F); (1.82 ±0.6 vs. 1.42 ±0.4 in both groups respectively. At the fourth hour; VAS was higher in groups (M) than in group (F); (2.80±0.8 vs. 1.76 ± 0.6 in both groups respectively. The incidence of complications was significantly lower among group (M) where 52% of patients had no complications at all. Conclusion the use of both magnesium and fentanyl as adjuvants to local anesthetics in epidural anesthesia is safe and effective. No significant differences regarding quality of motor block and hemodynamics. But the study shows that fentanyl is significantly a better adjuvant regarding postoperative analgesia and time for first analgesic dose. While magnesium is a significantly better adjuvant regarding complications such as nausea, vomiting and pruritis.