Silva Filho S E, Dainez S, Gonzalez M A M C, Angelis F, Vieira J E, Sandes C S
Department of Anesthesiology, Hospital da Sociedade Portuguesa de Beneficência de Santos, Santos, SP, Brazil.
Department of Anesthesiology, Universidade de Sao Paulo, Santos, SP, Brazil.
Anesthesiol Res Pract. 2022 Oct 26;2022:2642488. doi: 10.1155/2022/2642488. eCollection 2022.
Magnesium sulfate reduces pain scores and analgesic consumption. Its use as an analgesic resource in opioid-free or opioid-sparing techniques have also been tested. The evaluation of the antinociceptive potency of drugs and doses indirectly, through hemodynamic oscillations has been questioned. A relatively new algorithm called the plethysmographic stress index has been considered sensitive and relatively specific as a parameter for assessing the need for intraoperative analgesia.
The aim of this trial was to assess the intraoperative analgesic capacity of magnesium sulfate compared to remifentanil. The secondary objectives were propofol consumption and its latency, the consumption of opioids, ephedrine, and cisatracurium. . Forty patients scheduled for post-bariatric dermolipectomy were randomly assigned to two groups to receive total intravenous anesthesia with target-controlled hypnosis induced with propofol. Analgesia was obtained in the remifentanil group with remifentanil at an initial dose of 0.2 g·kg·min and in the magnesium sulfate group with magnesium sulfate 40 mg·kg + 10 mg·kg·h.
There was no statistical hemodynamic difference between the groups before and after orotracheal intubation ( = 0.062) and before and after the surgical incision ( = 0.656). There was also no statistical difference in the variation of mean arterial pressure before and after intubation ( = 0.656) and before and after the surgical incision ( = 0.911). There was similar consumption of cisatracurium, ephedrine, and postoperative opioids between the groups. Some patients in the magnesium sulfate group needed more intraoperative fentanyl and propofol, although the latency of propofol was similar in both the groups.
We conclude that using magnesium sulfate in intravenous general anesthesia for post-bariatric dermolipectomy is related to a significant reduction in opioid consumption without compromising hemodynamic stability. Overall, PSI monitoring was helpful in driving the analgesic strategy. The use of magnesium sulfate proved to be an important adjunct in the scenario presented, allowing the use of opioids to be avoided in certain cases. We found no statistical differences in the consumption of neuromuscular blocker and vasoconstrictor. Substituting opioids for magnesium sulfate leads to an increase in propofol consumption in the scenario presented. Studies with a larger sample are needed to corroborate the results presented and evaluate other potential advantages in reducing opioid consumption.
硫酸镁可降低疼痛评分并减少镇痛药物的使用量。其在无阿片类药物或减少阿片类药物使用的技术中作为一种镇痛资源的应用也已得到测试。通过血流动力学振荡间接评估药物和剂量的抗伤害感受效能受到了质疑。一种相对较新的算法，即体积描记压力指数，已被认为是评估术中镇痛需求的一个敏感且相对特异的参数。
本试验的目的是评估硫酸镁与瑞芬太尼相比的术中镇痛能力。次要目标是丙泊酚的使用量及其起效时间、阿片类药物、麻黄碱和顺式阿曲库铵的使用量。40例计划行减重术后皮肤切除术的患者被随机分为两组，接受丙泊酚诱导的靶控催眠全静脉麻醉。瑞芬太尼组初始剂量为0.2μg·kg·min的瑞芬太尼用于镇痛，硫酸镁组使用40mg·kg + 10mg·kg·h的硫酸镁用于镇痛。
两组在气管插管前后（P = 0.062）以及手术切口前后（P = 0.656）的血流动力学无统计学差异。插管前后平均动脉压的变化（P = 0.656）以及手术切口前后平均动脉压的变化（P = 0.911）也无统计学差异。两组间顺式阿曲库铵、麻黄碱和术后阿片类药物的使用量相似。硫酸镁组的一些患者术中需要更多的芬太尼和丙泊酚，尽管两组丙泊酚的起效时间相似。
我们得出结论，在减重术后皮肤切除术的静脉全身麻醉中使用硫酸镁与显著减少阿片类药物使用量相关，且不影响血流动力学稳定性。总体而言，PSI监测有助于制定镇痛策略。在本研究场景中，硫酸镁的使用被证明是一项重要的辅助措施，在某些情况下可避免使用阿片类药物。我们发现神经肌肉阻滞剂和血管收缩剂的使用量无统计学差异。在本研究场景中，用硫酸镁替代阿片类药物会导致丙泊酚使用量增加。需要更大样本量的研究来证实本研究结果，并评估在减少阿片类药物使用方面的其他潜在优势。
