Magnesium Sulfate versus Fentanyl as Adjuvant to Epidural Levobupivacaine in Surgeries below Umbilicus

Abstract

Background: Epidural anesthesia is performed to provide anesthesia for surgical procedures carried on lower abdomen, pelvis, and lower limbs. It offers superior pain relief and early mobilization especially when local anesthetic is combined with an adjuvant. Noxious impulses from damaged tissue evoke long lasting alterations in the central nervous system. Objective: The aim of the current study was to evaluate and compare between the effectiveness of adding magnesium sulphate versus addition of fentanyl to epidural levobupivacaine in onset of sensory and motor block, duration of analgesia , quality of block , intraoperative hemodynamics, post-operative pain control and post-operative side effects. Patients and Methods: The present study is a prospective randomized double blind controlled comparative study conducted for patients scheduled to undergo elective surgeries below umbilicus in Al-Azhar University Hospital in Assiut. After obtaining Institutional Ethics Committee approval and written informed consent, 90 patients ASA I/II were enrolled into the study. Results: this study demonstrated that magnesium, and fentanyl are effective as useful adjuvants to local anesthetic for epidural anesthesia. Magnesium sulphate is associated with a shorter onset of action of the epidural block with less nausea, vomiting and pruritis incidence, fentanyl have a prolonged duration but more incidence for those side effects. Conclusion: It could be concluded that magnesium sulfate and fentanyl are good adjuvants to local anesthetics when given epidurally, fentanyl provides more duration of analgesia but with more incidence of nausea vomiting and pruritis when compared to magnesium sulfate, but magnesium sulfate show more incidence of pain with injection.