الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 134 |  |  |
| | | from | 134 | | |
Abstract
Postoperative pain management is vital for patients with midline abdominal operations because severe pain is associated with difficulty in sleeping, decreased mobility, and atelectasis.(3, 4) These factors will result in high health care costs through delayed hospital discharge, less patient satisfaction, delayed postoperative mobilization, and enhancement of chronic postoperative pain.(5)
Recent multimodal approaches target incisional pain instead of visceral pain which leads to the emergence of abdominal field block.(20) RSB use has been described in a wide variety of surgeries.(21)
Local anesthetics provide good anesthesia in regional blocks but have a shorter duration of postoperative analgesia. Thereby, various adjuncts like opioids, clonidine, neostigmine, dexamethasone, dexmedetomidine, ketorolac, ketamine, and low-level laser therapy, have been used in regional blocks to achieve desirable analgesia.(35-37)
Magnesium sulfate is (NMDA) receptor antagonist in the central nervous system (CNS) andperipheralnervous system (PNS). Anti-nociceptive effects of magnesium are due to the regulation of calcium influx into the cell and antagonism of the NMDA receptors.
Adenosine is a purine.(41)Adenosine receptor agonists have been demonstrated to induce anti-nociception.(42, 43) At least two subtypes of adenosine receptors are involved in pain modulation and anti-allodynic effects are mediated through activation of A1 adenosine receptors.(44)
This study aimed to compare adenosine and magnesium sulfate as adjuvants for ultrasound-guided rectus sheath block.
This study was done in Menoufia University Hospitals on 96 healthy American Society of Anesthesiologists (ASA) class I or II aged 18-60 years old undergoing umbilical or epigastric hernia repair.
The participants were randomly allocated through sealed opaque envelopes into three groups with 32 patients in each group.
Adenosine group:got ultrasound-guided rectus sheath block (UG-RSB) using 20 ml of bupivacaine hydrochloride 0.25% + 12 mg adenosine(4ml) +1 ml saline 0.9% (total volume 25ml).
Magnesium group: got UG-RSB using 20 ml of bupivacaine hydrochloride 0.25% + 500 mg magnesium sulfate (5ml) (total volume 25ml).
Control group: got UG-RSB using 20 ml of bupivacaine hydrochloride 0.25% + 5 ml saline 0.9% (total volume 25ml).
Preoperative assessment of the patients wasdone through a detailed history and clinical examinations. Basic laboratory investigations were done such as CBC, SGPT, SGOT, UREA, CREATINE, and Coagulation profile.
Under complete aseptic technique and scrubbing, a single-injection ultrasound-guided RS block (Figure 11) was performed in all patients after induction of general anesthesia.
The total intraoperative fentanyl, surgery time, anesthesia time, and PACU stay were recorded. In the PACU the hemodynamic measurements and VAS score was recorded. Also postoperative 48 h morphine consumption was reported, PONV, somnolence and any adverse drug reactions like pruritus.
There were no statistically significant differences between the three groups regarding demographic data, intra-operative fentanyl consumption, surgery time and anesthesia time, and PACU stay between the three studied groups.
The present study demonstrated that magnesium sulfate and adenosine as adjuvants for bilateral UG-RSB were effective in improving the duration and intensity of postoperative analgesia, which was reflected by less postoperative opioid consumption with its side effects. Magnesium sulfate more effectively prolongs the duration of the block than adenosine, as well as it was associated with lower pain scores up to 18 hours. The decreased duration of analgesic action of adenosine may be due to rapid metabolism.
Ondansetron consumption was statistically significantly higher in the control group compared to the adenosine and magnesium group but with no difference between the magnesium and adenosine groups.
Other post-operative complaints (such as shivering, pruritus, and respiratory depression) were observed mainly among the control group. However, these differences were not statistically significant.
We concluded that Magnesium sulfate and adenosine are associated with better postoperative analgesia, also considered good adjuvants to improve the quality and duration of rectus sheath block and associated with fewer postoperative side effects such as respiratory depression, excessive sedation, and postoperative nausea and vomiting.