Effect of magnesium -lidocaine combination on outcome after severe head injury

ABSTRACT

Neuroprotection in the setting of severe head injury [SHI] remains unsettled problem. Our aim was to evaluate the efficacy and safety of a high dose magnesium and low dose lidocaine infused, over 3 days after SHI. Sixty adult patients with SHI [Glasgow Coma Scale Intensive Care Unit were included in this study. Patients were divided into two groups [30 patients in each], magnesium-lidocaine [Mg-Lid] group received magnesium sulfate [70 mg/kg IV bolus followed by 15 mg/kg/hr] plus lidocaine [1.5 mg /kg bolus IV followed by 1 mg /kg/hr] infused for 3 days and control group received placebo. Routine monitoring and laboratory investigations were obtained immediately after admission and every 24 hours thereafter for 3 consecutive days. These include vital signs, CT scan, GCS, serum glucose, serum electrolytes, creatinine, HCO3, and bilirubin. The outcome was estimated at 6 months using the Glasgow Outcome Scale [GOS]. The serum concentrations of ionized magnesium in the Mg-Lid group were significantly increased in all subsequent values as compared with baseline value and control group. The other assessed parameters were not changed from admission. Patients in the Mg-Lid group had a more favorable outcome [54%] when compared to the control group [38%].Mortality rate was significantly lower in the Mg- Lid group [27%] compared with the control group [46%]. In conclusion, magnesium-lidocaine combination administered according to the above regimen is safe and well tolerated after SHI. Patients in the Mg-Lid group showed a more favorable outcome and lower mortality rate when compared to the control group