Background and Aim: Laparoscopic cholecystectomy is the gold standard for treatment of symptomatic cholelithiasis. Laparoscopic cholecystectomy procedure offers several advantages such as a reduction in stress response, postoperative pain, short recovery time, and cosmetic appearance. we aimed at evaluating the postoperative analgesic efficiency of magnesium sulphate as pre emptive analgesic in patients undergoing laparoscopic cholecystectomy.

Materials and Methods: Sixty patients with ASA Grade I and Grade II undergoing laparoscopic cholecystectomy were included in study and divided in two groups. Patients in magnesium group(group MS)received i.v MGSO4 50 mg/kg in 100ml of 0.9% normal saline during Pre induction time and patients in the control group (group NS) received 100ml of 0.9% normal saline .Pre medicated with injection glycopyrolate 0.01mg/kg,inj midazolam0.03 mg/kg, inj. fentanyl 2µgm/kg was given to both groups. Effect of Magnesium sulphate infusion on post operative analgesic efficiency based on visual analogscoring, total tramadol consumption during first postoperative day, time for first rescue analgesia, post operative haemodynamic variables heart rate and MAP were assessed.

Result: Comparison of VAS scores ,at the time of extubation i.e 0 hr,2 hr,4 hr has statistically significance of P value i.e>0.05. With lower VAS scores in magnesium group compared to normal saline group. At 8 hr, 12 hr,24 hr has no statistical significant value between two groups.(P Value>0.05) Post operative tramadol consumpotion has significant difference (P<0.05) between magnesium sulphate and normal saline group. Tramadol consumption was more in normal saline group than magnesium group. There is a significant P value (P<0.05) for time for first rescue analgesia between magnesium and normal saline groups. The time taken for rescue analgesia was longer duration in magnesium group than normal saline group. With comparison of heart rates in 0 hr,2 hr postoperative period there is a statistically significant P value (P<0.05)observed. At 4 hr,8 hr,12 hr,24 hr there is no significance between among groups.(P value >0.05 Magnesium sulphate group has lesser incidence of side effects like shivering and post operative nausea and vomiting ,but more patients experienced sedation than normal saline group.

Conclusion: magnesium sulphate was a good pre-emptive analgesic that has better VAS scores and reduces the postoperative tramadol consumption than normal saline group with minimal side effects.

Keywords: laparoscopic cholecystectomy, preemptive analgesia, magnesium sulphate.

1. Gerges FJ, Kanazi GE, Jabbour-Khoury SI. (2006). Anesthesia for laparoscopy: a review.Journal of Clinical Anesthesia 2001; 18(1): 67-78.
2. Leonard IE, Cunningham AJ. Anesthetic consideration for laparoscopic cholecyst-ectomy. Best Practice & Research Clinical Anesthesiology 2002; 16(1): 1-20.
3. McMahon AJ, Fischbacher CM, Frame SH, MacLeod MC. Impact of laparoscopic cholecystectomy: a population-based study. Lancet 2000; 356(11): 1632-163.
4. WILLS VL, HUNT DR . Pain after laparoscopic cholecystectomy. Br J Surg 2000;87:273- 84.
5. Katz J, McCartney CJL. Current status of pre-emptive analgesia. CurrOpin Anaesthesiol 2002;15:435-41.
6. Liu J, Ding Y, White PF, Feinstein R, Shear JM: Effects of ketorolac on postoperative analgesia and ventilatory function after laparoscopic cholecyste-ctomy. AnesthAnalg 1993; 76:1061–6.
7. Naguib M, Seraj M, Attia M, Samarkandi AH, Seet M, Jaroudi R: Perioperative antinociceptive effects of tramadol: A prospective, randomized, double-blind comparison with morphine. Can J Anaesth 1998; 45:1168–75.
8. Pasqualucci A, de Angelis V, Contardo R, Colò F, Terrosu G, Donini A, Pasetto A, Bresadola F Anesthesiology [1996, 85(1):11-20]
9. Fujii Y, Toyooka H, Tanaka H: Efficacy of thoracic epidural analgesia following laparoscopic cholecystectomy. Eur J Anaesthesiol 1998; 15:342–4.
10. Kissin I. Preemptive analgesia. Anesthesiology 2000;93:1138-43.
11. Practice guidelines for acute pain management in the perioperative setting:An updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 2004; 100:1573–81.
12. Marret E, Kurdi O, Zufferey P, Bonnet F: Effects of nonsteroidal anti-inflammatory drugs on patient-controlled analgesia morphine side effects: Meta-analysis of randomized controlled trials. Anesthesiology 2005; 102:1249–60
13. White PF: The role of non-opioid analgesic techniques in the management of pain after ambulatory surgery. Anesth Analg 2002; 94:577-8
14. J. Woolf and M.-S. Chong, “Preemptive analgesia—treating postoperative pain by preventing the establishment of central sensitization,” Anesthesia and Analgesia, vol. 77, no. 2, pp. 362– 379, 1993.
15. D. Miller, Miller’s Anesthesia, vol. 31, Churchil Livingstone, San Diego, Calif, USA, 8th edition, 201.
16. Moher D, Liberati A, TetzalfJ , Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement .Plos Medicine 2009;34:269-74.
17. Wilder –Smith CH, Knopfil R, Wilder-Smith OH. Perioperative magnesium infusion and postoperative pain. Acta Anaesthesiol Scand 1997;41:1023-1027.
18. Fuchs-Buder T, Wilder-Smith OH, Borgeat A, Tassonyi E.Interaction of magnesium sulphate with vecuronium-induced neuromuscular block. Br J Anaesth 1994;74:404-9.
19. Kussman B, Shorten G, Uppington J, Comunale ME. Administration of magnesium sulphate before rocuronium: effects on speed of onset and duration of neuromuscular block.Br J Anaesth 1997;79:122-4.
20. Seyhan TO, Tugrul M, Sungur MO, Kayacan S, Telci L, Pembeci K, Akpir K , Effects of three different dose regimens of magnesium on propofol requirements, haemodynamic variables and postoperative pain relief in gynaecological surgery. .Br J Anaesth 2006 Feb;96(2):247-52.
21. Iva Bacak Kocman, Renata Krobot, Jadranka Premuzic , IvicaKocman , Ranko Stare, Lea Katalinic. The effect of preemptive intravenous low-dose magnesium sulfate on early postoperative pain after laparoscopic cholecystectomy. ActaClin Croat 2013; 52:289-294.
22. Mentes O, Harlak A, Yigit T, Balkan M, Cosar A, Savaser A, Kozak O, Tufan T. Effect of intraoperative magnesium sulphate infusion on pain relief after laparoscopic cholecystecyomy. Acta Anaesthesiol Scand.2008 Nov;52(10):1
23. DABBAGH1, H. ELYASI1 , S. S. RAZAVI1 , M. FATHI1 and S. RAJAEI2. Intravenous magnesium sulfate for post-operative pain in patients undergoing lower limb orthopedic surgery. Acta Anaesthesiol Scand 2009; 53: 1088–109.
24. Kogler, “The analgesic effect of magnesium sulfate in patients undergoing thoracotomy,” Acta Clinica Croatica, vol. 48, no. 1,pp. 19–26, 2009.353-9
25. -H. Ryu, M.-H.Kang, K.-S.Park, and S.-H. Do, “Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia,” British Journal of Anaesthesia, vol. 100, no. 3, pp. 397–403, 2008.
26. Hammad Usmani, Abdul Quadir, Mehtab Alam, Akhil Rohtagi, Gulrez Ahmed. Evaluation of perioperative Magnesium Sulphate infusion on postoperative pain and nalgesic requirements in patients undergoing upper abdominal surgery. J Anesth Clin Pharmacology 2007; 23(3): 255-258.

Dr P.Sudha Poornima

Department of Anaesthesiology, Andhra Medical College, Visakhapatnam