Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-28T00:15:50.738Z Has data issue: false hasContentIssue false
  • English
  • Français

Intravenous magnesium sulphate decreases postoperative tramadol requirement after radical prostatectomy

Published online by Cambridge University Press:  11 July 2006

P. Tauzin-Fin ,
M. Sesay ,
S. Delort-Laval ,
M. C. Krol-Houdek  and
P. Maurette
P. Tauzin-Fin
Affiliation:
DAR III Hôpital Pellegrin-Tondu Bordeaux, Bordeaux Cedex, France
M. Sesay
Affiliation:
DAR III Hôpital Pellegrin-Tondu Bordeaux, Bordeaux Cedex, France
S. Delort-Laval
Affiliation:
DAR III Hôpital Pellegrin-Tondu Bordeaux, Bordeaux Cedex, France
M. C. Krol-Houdek
Affiliation:
DAR III Hôpital Pellegrin-Tondu Bordeaux, Bordeaux Cedex, France
P. Maurette
Affiliation:
DAR III Hôpital Pellegrin-Tondu Bordeaux, Bordeaux Cedex, France
Get access

Abstract

Summary

Background: The purpose of this study was to assess whether the addition of intravenous magnesium sulphate (Mg) at the induction of anaesthesia to a balanced anaesthetic protocol including wound infiltration, paracetamol and tramadol resulted in improved analgesic efficiency after radical prostatectomy. Methods: We conducted a randomized, double-blind, controlled study. Thirty ASA I or II males scheduled to undergo radical retropubic prostatectomy with general anaesthesia were prospectively assigned to one of the two groups (n = 15 each). The Mg group (Gr Mg) received 50 mg kg−1 of MgSO4 in 100 mL of isotonic saline over 20 min immediately after induction of anaesthesia and before skin incision. The patients in the control group (Gr C) received the same volume of saline over the same period. At the time of abdominal closure, wound infiltration with 190 mg (40 mL) of ropivacaine was performed in both groups. Pain was assessed by a 10-point visual analogue scale in the recovery room starting from the time of tracheal extubation. Standardized postoperative analgesia included paracetamol and tramadol administered via a patient-controlled analgesia device. Results: In the postoperative period, both groups experienced an identical pain course evolution. Cumulative mean tramadol dose after 24 h was 226 mg in the magnesium group and 446 mg in the control group (P < 0.001). Postoperative nausea occurred in two patients in each group. Two vs. eight patients required analgesic rescue in magnesium and control groups, respectively (P = 0.053). Conclusions: This study shows that intravenous magnesium sulphate reduces tramadol consumption when used as a postoperative analgesic protocol in radical prostatectomy.

Keywords

MAGNESIUMPAIN POSTOPERATIVECOMBINED MODALITY THERAPYANALGESIC OPIOID, sufentanil, tramadolSURGERY, urologicANAESTHETICS LOCAL, ropivacaineACETAMINOPHEN
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 12 , December 2006 , pp. 1055 - 1059
Copyright
2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented in part in the World Congress of Anesthesiologists, Paris, France, 2004.

References

Tauzin-Fin P, Delort-Laval S, Guenard Yet al. Etude comparative de la buprénorphine et de son association au kétoprofène et au paracétamol pour l'analgésie postopératoire en chirurgie urologique. Ann Fr Anesth Réanim 1996; 15: 41–46.Google Scholar
Wheeler M, Oderda GM, Ashburn MA, Lipman AG. Adverse events associated with postoperative opioid analgesia: a systematic review. Clin J Pain 2002; 3: 159–180.Google Scholar
Dahl JB, Moiniche S, Kehlet H. Wound infiltration with local anaesthetic for postoperative pain relief. Acta Anaesthesiol Scand 1994; 38: 7–14.Google Scholar
Moiniche S, Mikkelsen S, Wetterslev J, Dahl JB. A qualitative systematic review of incisinal local anaesthesia for postoperative pain relief after abdominal operations. Br J Anaesth 1998; 81: 377–383.Google Scholar
Kehlet H, Dahl JB. The value of ‘multimodal’ or ‘balanced’ analgesia in the postoperative pain treatment. Anesth Analg 1993; 77: 1048–1056.Google Scholar
Kehlet H, Wermer M, Perkins F. Balanced analgesia: what is it and what are its advantages in postoperative pain. Drugs 1999; 58: 793–797.Google Scholar
Mc Bain CJ, Mayer ML. N-methyl-d-aspartic acid receptor structure and function. Physiol Rev 1994; 74: 723–760.Google Scholar
Tramer MR, Schneider J, Marti RA, Rifat K. Role of magnesium sulfate in postoperative analgesia. Anesthesiology 1996; 84: 340–347.Google Scholar
Koinig H, Wallner T, Marhofer Pet al. Magnesium sulfate reduces intra- and postoperative analgesic requirements. Anesth Analg 1998; 87: 206–210.Google Scholar
Levaux D, Bonhomme V, Dewandre PYet al. Effects of intraoperative magnesium sulphate on pain relief and patient comfort after major lumbar orthopaedic surgery. Anaesthesia 2003; 58: 131–135.Google Scholar
Kara H, Sahin N, Uhsan V, Aydogdu T. Magnesium infusion reduces postoperative pain. Eur J Anaesthesiol 2002; 19: 52–56.Google Scholar
Whiteside JB, Wildsmith JAW. Developments in local anaesthetic drugs. Br J Anaesth 2001; 87: 27–35.Google Scholar
Scott DB, Lee A, Fagan Det al. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 1989; 69: 563–569.Google Scholar
Johansson B, Glise H, Hallerback Bet al. Preoperative local infiltration with ropivacaine for postoperative pain relief after cholecystectomy. Anesth Analg 1994; 78: 210–214.Google Scholar
Horn EP, Schroeder F, Wilhelm Set al. Wound infiltration and drain lavage with ropivacaine after major shoulder surgery. Anesth Analg 1999; 89: 1461–1469.Google Scholar
Petterson N, Emanuelsson BM, Reventlid H, Hahn RG. High-dose ropivacaine wound infiltration for pain relief after inguinal hernia repair: a clinical and pharmacokinetic evaluation. Reg Anesth Pain Med 1998; 23: 189–196.Google Scholar
Lehmann KA. Tramadol in acute pain. Drugs 1997; 53 (Suppl 2): 25–33.Google Scholar
Pang WW, Mok MS, Lin CHet al. Comparison of patient controlled analgesia (PCA) with tramadol or morphine. Can J Anaesth 1999; 46: 1030–1035.Google Scholar
Bamigdale T, Langford R. The clinical use of tramadol hydrochloride. Pain Rev 1998; 5: 155–182.Google Scholar
Houmes RJ, Voets MA, Verkaaik Aet al. Efficacy and safety of tramadol versus morphine for moderate or severe postoperative pain with special regard to respiratory depression. Anesth Analg 1992; 74: 510–514.Google Scholar
Scott LJ, Perry CM. Tramadol: a review of its use in perioperative pain. Drugs 2000; 60: 139–176.Google Scholar
Snijdelaar DG, Koren G, Katz J. Effects of perioperative oral amantadine on postoperative pain and morphine consumption in patients after radical prostatectomy. Anesthesiology 2005; 100: 134–141.Google Scholar
Paqueron X, Lumbroso A, Mergoni Pet al. Is morphine-induced sedation synonymous with analgesia during intravenous morphine titration? Br J Anaesth 2002; 89: 697–701.Google Scholar
Kapfer B, Alfonsi P, Guignard Bet al. Nefopam and ketamine comparably enhance postoperative analgesia. Anesth Analg 2005; 100: 169–174.Google Scholar
James MF. Clinical use of magnesium infusions in anesthesia. Anesth Analg 1992; 74: 129–136.Google Scholar
Mao J, Price DD, Mayer DJ. Mechanisms of hyperalgesia and morphine tolerance: a review of their possible interaction. Pain 1995; 62: 259–274.Google Scholar
Laulin JP, Maurette P, Corcuff JBet al. The role of ketamine in preventing fentanyl-induced hyperalgesia and subsequent acute morphine tolerance. Anesth Analg 2002; 94: 1263–1269.Google Scholar
Dickenson AH. Spinal cord pharmacology of pain. Br J Anaesth 1995; 75: 193–200.Google Scholar
Richebe P, Rivat C, Laulin JPet al. Ketamine improves the management of exaggerated postoperative pain observed in perioperative fentanyl-treated rats. Anesthesiology 2005; 102: 421–428.Google Scholar
Kroin JS, McCarthy RJ, Von Roenn Net al. Magnesium sulfate potentiates morphine antinociception at the spinal level. Anesth Analg 2000; 90: 913–917.Google Scholar
Ng KF, Tsui SL, Yang JCet al. Increased nausea and dizziness when using tramadol for postoperative patient controlled analgesia (PCA) compared with morphine after intraoperative loading with morphine. Eur J Anesthesiol 1998; 15: 565–570.Google Scholar
Ng KF, Tsui SL, Yang JCet al. Comparison of tramadol and tramadol/droperidol mixture for patient-controlled analgesia. Can J Anaesth 1997; 44: 810–815.Google Scholar
Pang WW, Mok MS, Huang Set al. Intraoperative loading attenuates nausea and vomiting of tramadol patient-controlled analgesia. Can J Anesth 2000; 47: 968–973.Google Scholar
Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 1997; 78: 606–617.Google Scholar