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

Abstract

BackgroundMagnesium 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.MethodsNinety 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.ResultsVAS 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.ConclusionsContinuous presternal bupivacaine and magnesium infusion resulted in better postoperative analgesia than both presternal bupivacaine alone or conventional analgesic groups.

Can Continuous Local Anesthetic Infusion After Median Sternotomy Reduce Opioid Use?

“…There are standardized and documented pain scales defined for this assessment. In the literature, studies report that continued infusion of different local anesthetics after median sternotomy reduces scores on pain scales [ 16 , 20 ]. In our study, we evaluated our patient groups with the widely used VAS and PHHPS scales that questions painful symptoms, especially in necessary physical activities.…”

Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP)

“…Un metaanálisis de SUPLEMENTO • SEGUNDO SEMESTRE DE 2020 Revisión 2013 367 , recoge numerosas especialidades quirúrgicas en las que se empleó el magnesio como adyuvante de analgesia y concluye efectos beneficiosos y ahorro de opioides. Otras vías de administración, como la infiltración de la herida preesternal con magnesio asociado al anestésico local, se han descrito con aceptables resultados frente a técnicas de analgesia convencional 368 .…”

Analgesia after cardiac surgery

“…В недавно проведенном исследовании сравнивали эффективность инфузии местного анестетика в рану с традиционным методом обезболивания, т.е. назначением НПВС и опиоидов [19]. Пациенты после плановых реконструктивных операций на клапанах сердца были разделены на 3 группы: пациентам 1-й группы с целью обезболивания вводили 0,125% бупивакаин с 5% магнезией со скоростью 3 мл/ч в течение 48 ч через престернальный катетер; пациентам 2-й группы -только 0,125% бупивакаин с той же скоростью; пациенты 3-й группы получали кеторолак и парацетамол.…”

“…Это, в свою очередь, приводит к меньшему потреблению опиоидов в послеоперационном периоде и ранней экстубации пациентов. Однако следует отметить, что развитие в дальнейшем хронического болевого синдрома (по истечении 2 мес) наблюдалось в трех группах с одинаковой частотой [19].…”