ABSTRACT
Magnesium has been used as an adjuvant by various routes, including intravenous, intrathecal, and epidural in different dosage regimens. The effect of single bolus dose of magnesium as an adjuvant to fentanyl for postoperative analgesia has not been studied. This prospective randomized controlled trial was done to evaluate the efficacy of single bolus administration of magnesium epidurally as an adjuvant to epidural fentanyl for postoperative analgesia in patients undergoing total hip replacement under combined spinal epidural anesthesia. Sixty patients received combined spinal-epidural anesthesia with 2 mL of 0.5% hyperbaric bupivacaine intrathecally. After the surgery, patients were randomized into Group F [epidural fentanyl [1 microg/kg] in 10 mL saline] and Group FM [epidural magnesium [75 mg] along with fentanyl [1 microg/kg] in 10 mL saline]. Supplementary analgesia was provided by 50 mg intravenous tramadol if Verbal Rating Score [VRS] > 4. Patient's first analgesic requirement and duration of analgesia were recorded. The duration of analgesia was significantly longer for Group FM, 340 +/- 28.8 min, compared with Group F, 164 +/- 17.1 min [P=0.001]. The frequency of rescue analgesics required in 24-h postoperative period in Group FM [2.3 +/- 0.5] was significantly less than that in Group F [4.3 +/- 0.5] [P=0.001]. VRS was significantly lower in Group FM up to 4 h in the postoperative period [P=0.001]. Bromage scale was statistically insignificant at all points of time. The administration of magnesium [75 mg] as an adjuvant to epidural fentanyl [1 microg/ kg] for postoperative analgesia results in significantly lower VRS with prolonged duration of analgesia as compared with epidural fentanyl [1 microg/kg] alone. Concomitant administration of magnesium also reduces the requirement of breakthrough analgesics with no increased incidence of side effects
ABSTRACT
Measurement of respiratory quotient [RQ] and resting energy expenditure [REE] has been shown to be helpful in designing nutritional regimens. There is a paucity of the literature describing the impact of a feeding regimen on the energy expenditure patterns. Therefore, we studied the effect of continuous vs. intermittent feeding regimen in head-injured patients on mechanical ventilation on RQ and REE After institutional ethical approval, this randomized study was conducted in 40 adult male patients with head injury requiring controlled mode of ventilation. Patients were randomly allocated into two groups. Group C: Feeds [30 kcal/kg/day] were given for 18 h/day, with night rest for 6 h. Group I: Six bolus feeds [30 kcal/kg/day] were given three hourly for 18 h with night rest for 6 h. RQ and REE were recorded every 30 min for 24 h. Blood sugar was measured 4 hourly. Other adverse effects such as feed intolerance, aspiration were noted. Demographic profile and SOFA score were comparable in the two groups. Base line RQ [0.8 vs. 0.86] and REE [1527 vs. 1599 kcal/day] were comparable in both the groups [P>0.05]. RQ was comparable in both groups during the study period at any time of the day [P>0.05]. Base line RQ was compared with all other RQ values measured every half hour and fluctuation from the base line value was insignificant in both groups [P>0.05]. REE was comparable in both the groups throughout the study period [P>0.5]. Adequacy of feeding as assessed by EI/MREE was 105.7% and 105.3% in group C and group I, respectively. There was no significant difference in the blood sugar levels between the two groups [P>0.05]. We found from our study that RQ, REE, and blood sugar remain comparable with two regimens of enteral feeding - continuous vs. intermittent in neurosurgical patients on ventilator support in a ICU setup