Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.004
Brazilian Journal of Anesthesiology
Clinical Research

Analgesic and hemodynamic effects of intravenous infusion of magnesium sulphate versus dexmedetomidine in patients undergoing bilateral inguinal hernial surgeries under spinal anesthesia: a randomized controlled study

Efeitos analgésicos e hemodinâmicos da infusão intravenosa de sulfato de magnésio versus dexmedetomidina em pacientes submetidos a cirurgias herniárias inguinais bilaterais sob raquianestesia: estudo controlado randomizado

Inas Farouk, Mohamed Mahmoud Hassan, Ahmed Mohamed Fetouh, Abd Elhay Abd Elgayed, Mona Hossam Eldin, Bassant Mohamed Abdelhamid

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Abstract

Background
Spinal anesthesia is commonly employed during inguinal hernial surgeries. Its short duration may, however, be considered a limitation, especially for bilateral hernial repair. The aim of this research is to investigate the analgesic and hemodynamic effects of intravenous infusion of both MgSO4 and dexmedetomidine on patients undergoing bilateral inguinal hernia surgeries under spinal anesthesia.

Methods
This study was a prospective, randomized, double-blinded controlled trail. It included 60 male patients who had been scheduled for bilateral elective inguinal hernia surgery under spinal anesthesia at Kasr Al-Aini hospital. Patients were randomly allocated to one of three groups (n = 20 each) to receive 50 mL of 0.9% saline intravenous infusion of either dexmedetomidine 0.5 μg.kg-1. h-1 (Group D) or magnesium sulphate 15 mg.kg-1. h-1 (Group M) or normal saline (Group S). The primary outcome of this study was set as the total duration of analgesia Secondary outcomes were set as the onset and duration of sensory and motor blockade, perioperative hemodynamics, and the total 24 -h postoperative morphine consumption.

Results
Durations of sensory and motor blockades as well as durations of analgesia were all significantly longer among patients in Group D (mean 2.2, 3.5, 5.8 -hs respectively) and Group M (mean 2.2, 3.3, 5.2 -hs respectively), in comparison to Group S (mean 1.5, 2.7, 3.9 -hs respectively). No significant differences were found in systolic or diastolic arterial blood pressure, heart rate oxygen saturation, cardiac output, or stroke volume among the study groups. Seven patients in group D and four patients in Groups M and S developed hypotension.

Conclusion
Intravenous infusion of either dexmedetomidine or MgSO4 with spinal anesthesia effectively improves the quality of spinal anesthesia and prolongs the duration of postoperative analgesia and decreases the 24 -h postoperative morphine consumption. Results also demonstrated that the use of dexmedetomidine resulted in a slightly longer duration of analgesia, whilst the use of MgSO4 resulted in slightly better hemodynamic stability.

Keywords

Magnesium sulphate;  Dexmedetomidine;  Spinal anesthesia;  Bilateral inguinal herniorrhaphy

Resumo

Introdução: A raquianestesia é comumente empregada durante cirurgias de hérnia inguinal. Sua curta duração pode, entretanto, ser considerada uma limitação, especialmente para a correção herniária bilateral. O objetivo desta pesquisa é investigar os efeitos analgésicos e hemodinâmicos da infusão intravenosa de MgSO4 e dexmedetomidina em pacientes submetidos a cirurgias de hérnia inguinal bilateral sob raquianestesia. Métodos: Este estudo foi um ensaio prospectivo, randomizado, duplo-cego controlado. Ele incluiu 60 pacientes do sexo masculino que haviam sido agendados para cirurgia de hérnia inguinal bilateral eletiva sob raquianestesia no hospital Kasr Al-Aini. Os pacientes foram alocados aleatoriamente em um dos três grupos (n = 20 cada) para receber 50 mL de solução salina a 0,9% infusão intravenosa de dexmedetomidina 0,5 µg.kg-1. h-1 (Grupo D) ou sulfato de magnésio 15 mg.kg-1. h-1 (Grupo M) ou solução salina normal (Grupo S). O desfecho primário deste estudo foi definido como a duração total da analgesia. Os desfechos secundários foram definidos como o início e a duração do bloqueio sensorial e motor, a hemodinâmica perioperatória e o consumo total de morfina no pós-operatório de 24 horas. Resultados: As durações dos bloqueios sensorial e motor, bem como as durações da analgesia foram significativamente maiores entre os pacientes do Grupo D (média de 2,2, 3,5, 5,8 horas, respectivamente) e do Grupo M (média de 2,2, 3,3, 5,2 horas, respectivamente), em comparação com Grupo S (média 1,5, 2,7, 3,9 horas, respectivamente). Não foram encontradas diferenças significativas na pressão arterial sistólica ou diastólica, saturação de oxigênio, frequência cardíaca, débito cardíaco ou volume sistólico entre os grupos de estudo. Sete pacientes do Grupo D e quatro pacientes dos Grupos M e S desenvolveram hipotensão. Conclusão: A infusão intravenosa de dexmedetomidina ou MgSO4 com raquianestesia melhora efetivamente a qualidade da raquianestesia e prolonga a duração da analgesia pós-operatória e diminui o consumo de morfina pós-operatória de 24 horas. Os resultados também demonstraram que o uso de dexmedetomidina resultou em tempo de analgesia um pouco mais longo, enquanto o uso de MgSO₄ resultou em estabilidade hemodinâmica um pouco melhor.

Palavras-chave

Sulfato de magnésio; Dexmedetomidina; Raquianestesia; Herniorrafia inguinal bilateral.

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