Laparoskopik histerektomide intraoperatif magnezyum sülfat infüzyonunun erken postoperatif opioid tüketimine etkisi: Randomize, çift kör, kontrollü çalışma

Öz

Amaç: Standart multimodal analjezi rejimine eklenen intraoperatif intravenöz magnezyum sülfatın, laparoskopik histerektomi sonrası ilk 24 saatte kümülatif opioid tüketimini azaltıp azaltmadığını araştırmak. Gereç ve Yöntemler: Bu tek merkezli, prospektif, randomize, çift kör, plasebo kontrollü çalışmada laparoskopik histerektomi planlanan 40 erişkin hasta 1:1 oranında randomize edilerek magnezyum sülfat (20 mg/kg IV yükleme dozu, ardından cerrahi sonuna kadar 20 mg/kg/ saat sürekli infüzyon) veya eş hacimde %0.9 NaCl aldı. Postoperatif analjezi, önceden tanımlanmış multimodal rejim ve fentanil bazlı hasta kontrollü analjezi ile standartlaştırıldı. Sayısal Derecelendirme Skalası (NRS) ağrı skoru ≥ 4 olduğunda kurtarma analjezisi olarak tramadol uygulandı. Birincil sonlanım noktası, postoperatif ilk 24 saatteki toplam opioid tüketiminin morfin miligram eşdeğeri (MME) idi. İkincil sonlanım noktaları; belirlenmiş zaman noktalarında istirahatte ve hareketle NRS ağrı skorları, postoperatif bulantı-kusma (PONV), Ramsay sedasyon skorları (RSS), kurtarma analjezik gereksinimi ve intraoperatif hemodinamik değişkenlerdi. Bulgular: Toplam fentanil tüketimi (255 [182.5–392.5] μg’ye karşı 465.0 [262.5–500.0] μg p=0.008) ve toplam opioid tüketimi MME (34.5 [26.9– 42.9] mg’ye karşı 50.0 [31.3–69.1] mg p=0.011) magnezyum grubunda anlamlı olarak daha düşüktü. NRS skorları, PONV insidansı ve RSS skorları hiçbir zaman noktasında farklılık göstermedi. Ortalama arter basıncı magnezyum grubunda 20. dakikada daha yüksekti (p=0.011), hipotansiyon ve bradikardi oranları ise benzerdi. Sonuç: İntraoperatif magnezyum sülfat, ağrı skorlarında iyileşme sağlamaksızın postoperatif 24 saatlik opioid gereksinimini azaltmıştır. Bu bulgu, multimodal analjezi içinde magnezyumu opioid azaltıcı bir adjuvan ajan olarak desteklemektedir.

Anahtar Kelimeler

• Laparoscopy
• hysterectomy
• magnesium sulfate
• patient-controlled analgesia
• postoperative pain

Effect of intraoperative magnesium sulfate infusion on early postoperative opioid consumption in laparoscopic hysterectomy: a randomized, double-blind, controlled trial

Öz

Aim: To investigate whether intraoperative intravenous magnesium sulfate, added to a standard multimodal analgesia regimen, reduces cumulative opioid consumption during the first 24 hours after laparoscopic hysterectomy. Material and Methods: In this single-center, prospective, randomized, double-blind, placebo-controlled trial, 40 adults scheduled for laparoscopic hysterectomy were randomized (1:1) to receive magnesium sulfate (20 mg/kg IV loading dose followed by a continuous infusion of 20 mg/kg/h until the end of surgery) or an equal volume of 0.9% saline. Postoperative analgesia was standardized using a predefined multimodal regimen and fentanyl based patient controlled analgesia; tramadol was administered as rescue analgesia when the Numeric Rating Scale (NRS) pain score was ≥ 4. The primary outcome was total opioid consumption within the first 24 postoperative hours, expressed as morphine milligram equivalents (MME). Secondary outcomes included NRS pain scores at rest and with movement at prespecified time points, postoperative nausea and vomiting (PONV), Ramsay sedation scores, rescue analgesic requirement, and intraoperative hemodynamic variables. Results: Total fentanyl consumption (255 [182.5–392.5] μg vs 465.0 [262.5–500.0] μg; p=0.008) and total opioid consumption MME (34.5 [26.9–42.9] mg vs 50.0 [31.3–69.1] mg; p=0.011) were significantly lower in the magnesium group. NRS scores, PONV incidence, and Ramsay sedation scores did not differ at any time point. Mean arterial pressure was higher at minute 20 in the magnesium group (p=0.011), while hypotension and bradycardia rates were comparable. Conclusion: Intraoperative magnesium sulfate reduced 24 h postoperative opioid requirements without improving pain scores, supporting magnesium as an opioid-sparing adjunct within multimodal analgesia.

Anahtar Kelimeler

• Laparoscopy
• hysterectomy
• magnesium sulfate
• patient-controlled analgesia
• postoperative pain

Kaynakça

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