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

BACKGROUND: Magnesium 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. METHODS: Ninety 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. RESULTS: VAS 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. CONCLUSIONS: Continuous presternal bupivacaine and magnesium infusion resulted in better postoperative analgesia than both presternal bupivacaine alone or conventional analgesic groups.

Combined spinal epidural anesthesia in patients with dilated cardiomyopathy undergoing vascular surgery in the lower half of the body

Dilated cardiomyopathy [DCM] is characterized by ventricular dilatation and impaired systolic cardiac Junction. Anesthetic management, of patients with cardiomyopathy with reduced systolic Junction, is challenging and may be associated with high mortality. The purpose of this study was to evaluate the hemodynamic effects of combined spinal epidural anesthesia [CSEA] in patients with dilated cardiomyopathy, underwent vascular surgery in the lower half of the body, in addition to assess the safety of this anesthetic technique in the early postoperative period. After approval by local research ethics committee of the Faculty of Medicine, and informed written consent obtained from all patients, 24 patients having dilated cardiomyopathy, subjected to vascular surgery in the lower half of the body under CSEA. The effects of CSEA on hemodynamics; IBP, HR and CVP [measured at base line and then every 10 min], in addition to cardiac complications during the hospital stay period were studied. patients had significant decrease in MAP in all readings after the base line one with maximal decrease at 70 min [-14.7%], while HR increased significantly in all readings after the base line one except the last reading with maximal increase at 50 min [13.1%]. CVP showed insignificant changes in all readings except at 90 and 100 min which showed significant increase [p< 0.05]. Four patients developed ECG changes in the postoperative period, while no significant changes in EF. combined spinal epidural anesthesia [CSEA] may be an alternative to general anesthesia in patients with dilated cardiomyopathy undergoing vascular surgery in the lower half of the body, as our patients had a largely im eventful postoperative recovery with good pain control