The efficacy of intravenous magnesium sulfate versus intravenous paracetamol on children posttonsillectomy pain and analgesic requirement: A randomized controlled study

Abstract

Background:One of the most common complications of tonsillectomy is pain, which leading to delayed recovery and later hospital discharge.Aims:We intended to compare the efficacy of magnesium sulfate versus paracetamol on the posttonsillectomy pain and analgesic requirement.Settings and Design:This study design was a prospective randomized controlled double-blinded clinical study.Patients and Methods:A total of 60 children with the American Society of Anesthesiologists physical status classes I and II, aged 3–12 years, scheduled for tonsillectomy were randomly divided into two groups each group contains 30 patients: (Group M): received an initial loading dose of magnesium sulfate 30 mg/kg over 15 min started with induction followed by continuous infusion of 10 mg/kg/h for 1 h regardless of the operation time and (Group P): received paracetamol infusion 10 mg/kg started with induction and continued for 1 h. Postoperatively, a blinded postanesthesia care unit (PACU) nurse observed the quality of analgesia using the face, legs, activity, cry, and consolability pain scores, bleeding, and sedation.Statistical Analysis Used:Student's t-test and Chi-square test were used for analysis.Results:Regarding postoperative pain, there was a statistically significant difference between the two groups at the time of admission in PACU (P = 0.025) as children who experienced pain already had taken rescue analgesic to alleviate pain. There was a statistically significant difference between the two groups regarding the need for analgesics (P = 0.038). There was no statistically significant difference regarding bleeding and sedation scores between the two study groups.Conclusions:Magnesium sulfate provided better postoperative analgesia and reduced need for analgesics after tonsillectomy compared to paracetamol, and regarding the incidence of bleeding and the degree of sedation the outcome in both groups was readily comparable.

Effect of Paracetamol and Magnesium Sulfate on Level of Pain and Opioid Intake following Orthognathic Surgery: A Clinical Trial

“…Magnesium sulfate also showed optimal analgesic efficacy in the present study. Hamed and Al-Saeed [16] assessed the efficacy of intravenous magnesium sulfate versus intravenous paracetamol on pain in children after tonsillectomy and the need for analgesics. They evaluated 60 children between 3 to 12 years in two groups of magnesium sulfate and paracetamol infusion.…”

“…Mostafa et al [15] evaluated the prophylactic effect of intravenous infusion of magnesium on postoperative sore throat after thyroid surgery and reported that it significantly decreased the incidence and severity of sore throat after thyroidectomy. Hamed and Al-Saeed [16] assessed the efficacy of intravenous magnesium sulfate versus intravenous paracetamol on pain in children after tonsillectomy and the need for analgesics and reported that magnesium sulfate had superior analgesic efficacy compared with paracetamol, and decreased the need for analgesics. However, Kalani et al [12] compared the analgesic effects of paracetamol and magnesium sulfate on pain during surgery and found that although administration of narcotics decreased by the use of paracetamol and magnesium sulfate, this reduction was not significant.…”

Comparison of intravenous injection of magnesium sulfate and lidocaine effectiveness on the prevention of laryngospasm and analgesic requirement in tonsillectomy

“… 12 Recently, the use of magnesium sulfate in reducing postoperative pain has been studied. 12 Lidocaine is one of the antiarrhythmic drugs and its main mechanism of action is blocking voltage-gated Na + channels that inhibit the activity of the upper laryngeal nerve and reduces the long-term blockage of the glottis. It is used locally (in the area of the tonsils) or intravenously to prevent laryngospasm, but it may reduce the seizure threshold.…”

“…2 Postoperative pain control after the tonsillectomy has a very important role in recovery time, hospitalization duration, hemodynamic effects, bleeding, nausea, vomiting, and financial costs. 12 Recently, the use of magnesium sulfate in reducing postoperative pain has been studied. 12 Lidocaine is one of the antiarrhythmic drugs and its main mechanism of action is blocking voltage-gated Na + channels that inhibit the activity of the upper laryngeal nerve and reduces the long-term blockage of the glottis.…”

“…Comparison of awaking time and the recovery duration between the two groups.The results of a meta-analysis performed byXie et al (2017) 2 are in concordance with the findings of the present study, and showed that the rate of analgesicrequirement in the magnesium group was significantly lower than the control group, but in contradiction to our findings, the rate of nausea and vomiting had no difference with the control group. Results of a clinical trial performed by Hamed et al (2015)12 on 60 children who were tonsillectomy candidates (30 patients received IV magnesium sulfate (30 mg/kg) and 30 patients received paracetamol (10 mg/kg)) showed that the magnesium sulfate group had lower pain and analgesic requirement in comparison to the paracetamol group. This is in concordance with results of the present study whose limitations are the low sample size and the lack of a control group.…”