Abdominal Hysterectomy
Conditions
Brief summary
The present study aims to compare the effect of adding IV magnesium sulfate versus magnesium sulfate to intrathecal hyperbaric bupivacaine in total abdominal hysterectomy regarding the duration of postoperative analgesia, hemodynamic stability, and complications.
Detailed description
Abdominal Hysterectomy (AH) is associated with an intense inflammatory response that can result in moderate to severe postoperative pain, sometimes difficult to control. Postoperative pain can cause many complications such as restlessness, increased sympathetic activity, high blood pressure, and tachycardia. Opioids are effective analgesics; however, they produce unwanted side effects, such as respiratory depression, nausea, and vomiting. Nonopioid drugs can decrease opioid usage and dependency. Different adjuvants have been added to local anesthetics to increase the duration of the regional anesthesia, decrease pain-relieving drugs, and delay the onset of postoperative pain. According to numerous reports, Magnesium sulfate has analgesic effects and lowers opioid consumption in many surgeries especially abdominal surgeries. The analgesic properties of magnesium are based on acting as a non-competitive antagonist of N-Methyl-D-Aspartate (NMDA) receptors in central nervous system and regulating the calcium influx into the cell. These properties avoid the central sensitization mechanisms due to the stimulation of peripheral nociceptive nerves In the spinal cord, magnesium sulfate decreases pain transmission by hyperpolarizing spinal interneurons via G-protein-mediated activation of potassium channels and by decreasing the release of the neurotransmitters (substance P and glutamate) from primary afferent terminals. Adequate postoperative pain relief can enhance recovery and increase patient satisfaction.
Interventions
DRUGMagnesium sulfate
IV magnesium sulfate versus magnesium sulfate to intrathecal hyperbaric bupivacaine
Sponsors
Assiut University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
FEMALE
Age
40 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Patients between 40-65 years old * Patients with ASA clinical status I/II * Patients eligible for abdominal hysterectomy * Oncological surgery
Exclusion criteria
* Body mass index (BMI) ≥ 40/kg / m2 * Previous abdominal surgery (except cesarean section) * Severe cardiovascular, renal, and hepatic dysfunction * Contraindications to spinal anesthesia * Neuromuscular diseases * Inappropriate for spinal anesthesia * Patient refusal
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| effect on postoperative pain after abdominal hysterectomy using visual analog score | Baseline | the pain intensity assessment at rest and on movement (from lying to sitting on the bed) using Visual analog score (VAS) This will measure pain intensity from 0 to 10 (goal is to be \< 4) 0: no pain 3: mild pain 7: moderate pain 10: severe pain |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| sedation by Ramsay sedation scale | Baseline | From 1 to 6 1. Patient is anxious and agitated or restless, or both. 2. Patient is cooperative, oriented, and tranquil. 3. Patient responds to commands only. 4. Patient exhibits brisk response to light glabellar tab or loud auditory stimulus. 5. Patient exhibits a sluggish response to light glabellar tap or loud auditory stimulus. 6. Patient exhibits no response. |
| time of the first opioid request | Baseline | time of the first opioid request, concentration and the occurrence of complications (hypotension, bradycardia, itching, urinary retention.) all over 24 hours postoperatively. |
| Mean arterial blood pressures (MAP) | Baseline | mean arterial blood pressures (MAP) will be recorded at time 0 then every 15 minutes in the first 2 hours, then at 6, 12, 24 hours postoperatively. |
| Heart rate (HR) | Baseline | Heart rate (HR) will be recorded at time 0 then every 15 minutes in the first 2 hours, then at 6, 12, 24 hours postoperatively. |
Contacts
Primary ContactMarwa S Hassanein, Res
Backup ContactAhmed M Elsonbaty, Lecturer
Outcome results
None listed