Korean J Pain.  2018 Apr;31(2):93-101. 10.3344/kjp.2018.31.2.93.

Pain alleviation in patients undergoing cardiac surgery; presternal local anesthetic and magnesium infiltration versus conventional intravenous analgesia: a randomized double-blind study

• Kamel EZ
• Abd-Elshafy SK
• Sayed JA
• Mostafa MM
• Seddik MI

• KMID: 2410831
• DOI: http://doi.org/10.3344/kjp.2018.31.2.93

Abstract

BACKGROUND
Magnesium is one of the effective, safe local anesthetic adjuvants that can exert an analgesic effect in conditions presenting acute and chronic post-sternotomy pain. We studied the efficacy of continuous infusion of presternal magnesium sulfate with bupivacaine for pain relief following cardiac surgery.
METHODS
Ninety adult patients undergoing valve replacement cardiac surgery randomly allocated into three groups. In all patients; a presternal catheter was placed for continuous infusion of either 0.125% bupivacaine and 5% magnesium sulfate (3 ml/h for 48 hours) in group 1, or 0.125% bupivacaine only in the same rate in group 2, versus conventional intravenous paracetamol and ketorolac in group 3. Rescue analgesia was iv 25 µg fentanyl. Postoperative Visual Analog Scale (VAS) and fentanyl consumption during the early two postoperative days were assessed. All patients were followed up over two months for occurrence of chronic post-sternotomy pain.
RESULTS
VAS values showed high significant differences during the first 48 hours with the least pain scale in group 1 and significantly least fentanyl consumption (30.8 ± 7 µg in group 1 vs. 69 ± 18 µg in group 2, and 162 ± 3 in group 3 respectively). The incidence of chronic pain has not differed between the three groups although it was more pronounced in group 3.
CONCLUSIONS
Continuous presternal bupivacaine and magnesium infusion resulted in better postoperative analgesia than both presternal bupivacaine alone or conventional analgesic groups.

Keyword

Bupivacaine; Chronic post-sternotomy; Cardiac surgery; Magnesium; Pain; Post-operative

MeSH Terms

Acetaminophen
Adjuvants, Anesthesia
Adult
Analgesia*
Bupivacaine
Catheters
Chronic Pain
Double-Blind Method*
Fentanyl
Humans
Incidence
Ketorolac
Magnesium Sulfate
Magnesium*
Thoracic Surgery*
Visual Analog Scale
Acetaminophen
Adjuvants, Anesthesia
Bupivacaine
Fentanyl
Ketorolac
Magnesium
Magnesium Sulfate

Figure

• 

  Fig. 1 CONSORT flow diagram.

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  Fig. 2 Visual analogue scale (VAS) of the three studied groups at different. Group 1: bupivacaine with magnesium group, Group 2: bupivacaine group, Group 3: conventional intravenous analgesics group. *P < 0.05 was considered statistically significant between the three studied groups.

• 

  Fig. 3 Incidence of chronic pain in the three groups after two months follow up. Group 1: bupivacaine with magnesium group, Group 2: bupivacaine group, Group 3: conventional intravenous analgesics group. Data are presented as number.

• 

  Fig. 4 Cortisol level of the three studied groups. Group 1: bupivacaine with magnesium group, Group 2: bupivacaine group, Group 3: conventional intravenous analgesics group. Data are presented as mean ± SE.

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