Comparison of Analgesia in Subcutaneous Infiltration of Ropivacaine and Magnesium Sulfate for Postoperative Pain Control of Cholecystectomy

Novelty in Biomedicine Original Article Comparison of Analgesia in Subcutaneous Infiltration of Ropivacaine and Magnesium Sulfate for Postoperative Pain Control of Cholecystectomy Shayesteh Khorasanizadeh1, Maryam Panahi1, Gholamreza Mohseni1, Faranak Behnaz1, Masih Ebrahymy Dehkordy1, Houman Teymourian1* 1 Department of Anesthesia, Shohada Tajrish hospital, Shahid Behesti university of Medical Sciences, Tehran, Iran Received: 28 May, 2019; Accepted: 24 September, 2019 Abstract Background: The purpose of this study was to compare the effect of analgesia of Ropivacaine and magnesium sulfate as subcutaneous infiltration at the site of surgical cutaneous cholecystectomy in the postoperative period. Materials and Methods: To achieve the research goals, 80 patients referred to Shohada Tajrish Hospital in Tehran in 2016, which were randomly divided into two groups: Ropivacaine and magnesium sulfate. Patients in both groups had similar anesthetic procedures and all of them were monitored standard were recorded within 24 hours of operation. Overall morphine dose was also recorded for postoperative pain. Results: The findings showed that there was a significant difference between the two groups in the Ropivacaine group in the next hours despite the no significant difference in age, sex, BMI, duration of operation and pain scoring at first and third hours. In addition, the comparison of the number of requests for at least one dose of morphine in the Ropivacaine group is significantly lower. In addition, the comparison of the number of requests for at least one dose of morphine in the Ropivacaine group is significantly lower. The occurrence of PONV is also higher in the magnesium sulfate group, but this difference is not significant. Conclusion: Local injection of Ropivacaine reduced acute pain after open cholecystectomy surgery in comparison to local injection of magnesium sulfate. In addition, the use of Ropivacaine is associated with a significant reduction in the need for intravenous morphine for analgesia. Keywords: Magnesium sulfate, Ropivacaine, VAS, Open cholecystectomy *Corresponding Author: Houman Teymourian, MD; Associate professor, Department of Anesthesia, Shohada Tajrish hospital, Shahid Behesti university of Medical Sciences, Tehran, Iran. Email: Please cite this article as: Khorasanizadeh Sh, Panahi M, Mohseni Gh, Behnaz F, Ebrahymy Dehkordy M, Teymourian H. Comparison of Analgesia in Subcutaneous Infiltration of Ropivacaine and Magnesium Sulfate for Postoperative Pain Control of Cholecystectomy. Novel Biomed. 2020;8(1):13-19. Introduction it was the eighth surgery in the US operating room2. Cholecystectomy can be done either open or laparoscopic. Open cholecystectomy is done with a surgical incision of 12-8 cm and under the edge of the ribs on the right side3 and the pain after this, is a common problem for patients. Reducing postoperative pain will facilitate functional Cholecystectomy is a surgical procedure for the removal of gallbladder and a common therapeutic treatment for Gallstone symptoms and other pathologies1, and in 2011, the 8th surgery in the operating room was in the United States and in 2011 NBM 13 Novelty in Biomedicine 2020, 1, 13-19 Khorasanizadeh et al. Comparison of Analgesia in Subcutaneous Infiltration of Ropivacaine and Magnesium … recovery, the length of hospital stay and reducing postoperative morbidity and uncontrolled pain after surgery, causing chronic postoperative pain4. Despite the major complications of high-dose opiates such as respiratory supplements, ileus, nausea and vomiting, they are still the main drug for controlling postoperative pain, and, on the other hand, reducing the dose of opiate can increase the amount of postoperative pain. Substitutes for opiates are nonsteroidal anti-inflammatory drugs (NSAIDs), which also have side effects including reduced homeostasis, renal dysfunction and gastrointestinal bleeding. Different methods have been used to control postoperative pain in abdominal surgery. Among the peripheral nervous block5, injection of Ropivacaine into the peritoneum, and the effect of local infiltration of tramadol, Ropivacaine, Lidocaine in the subcutaneous site of surgery, have been considered in some studies. Magnesium sulfate is an auxiliary drug in controlling pain by antagonizing the calcium channel in the NMDA receptor6,7. Also, magnesium is a safe and inexpensive drug that can reduce postoperative pain and reduce pain relief8,9. In general, upper abdominal surgery causes more pain than lower abdominal surgery, which usually lasts for 48 to 72 hours and is considered to be moderate to severe pain in severity10-12. Although today laparoscopic cholecystectomy is most commonly done by laparoscopy, but some cases of this operation are performed in certain circumstances. Postoperative analgesia plays an important role in the recovery of the patient, since the inflammatory mediators released after surgical trauma have a deleterious effect on the functioning of the organs of the body and the recovery of the patient after surgery13,14. Complications due to lack of adequate control of pain during the postoperative period include the release of neuroendocrine hormone and cytokines, which in the cardiovascular system leads to hypertension, tachycardia, dysrhythmia, and ultimately myocardial schizoids15 and reduces FRC in the pulmonary system16,17, increased respiratory rate of hypoxemia, Hypercapnia, and pneumonia in susceptible individuals. In the GI system, control of the GI reflex18 and the decrease in the activity of the immune system19, and all of these complications postoperative pain control is necessary. Various techniques have NBM been proposed to eliminate postoperative pain. High levels of opiates are often needed to control severe postoperative pain, which is associated with multiple side effects20. Lesion infiltration with local anesthetics is an easy and effective method for controlling postoperative pain that has recently been used extensively21-23. But the effect of this method is not clear enough to control postoperative pain. The two groups of magnesium sulfate and Ropivacaine were compared in this way. Regarding the high prevalence of cholecystectomy surgery and the adverse effects of pain on the body and quality of life of patients, and the use of opiates and systemic analgesics after surgery is associated with complications and because of repeated appearances with dissatisfaction of patients with epidural analgesia, it seems that the choice of local analgesia is preferable in some cases. The cost-effectiveness and availability of used drugs is another reason to choose it. In a case control study by Demiroglu et al6, which is done in Turkey, the effect of using systemic and regional magnesium sulfate on the amount of tramadol was studied in patients undergoing laminectomy surgery and observed that tramadol consumption was significantly lower in group B than in the other two grou (...truncated)