Opioid Sparing General Venous Anesthesia With Magnesium Sulfate
Condition: Magnesium Sulfate; Postoperative Pain; Opioid Use
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Magnesium sulfate has been shown to be useful in many situations in medicine, such as
      eclampsia prevention and treatment, pulmonary hypertension, arterial pressure, asthma,
      cardiac arrhythmias and pheochromocytoma. Recently there has been a growing a big interest in
      this drug as an useful adjuvant in anesthesia, with analgesic and anesthetic sparing effect,
      antihyperalgesic property and potentialization of the neuromuscular blocker agent effect. On
      the other hand there has been a growing concern related to opioid administration, such as
      hyperalgesia, delayed return of intestinal function and the (still controversial) possibility
      of facilitating effect on tumor growth and metastases in cancer patients.

      This project is based on a previous randomized, double blind prospective trial (conducted by
      one of these authors and not yet published) comparing two groups of patients who received
      general intravenous total anesthesia with propofol in controlled target infusion.

      The surgical stress index is obtained by the interaction between the interval between heart
      beats and the amplitude of the photoplethysmography wave, whose algorithm generates a number
      related to the hemodynamic result of the increase of the sympathetic tone, which has shown to
      be the most sensitive resource in detecting the imbalance between the stimulus nociceptive
      and anti-nociception.
    

Detailed description: 
      Magnesium sulfate has been shown to be useful in many situations in medicine, such as
      eclampsia prevention and treatment, pulmonary hypertension, arterial pressure, asthma,
      cardiac arrhythmias and pheochromocytoma. Recently there has been a growing a big interest in
      this drug as an useful adjuvant in anesthesia, with analgesic and anesthetic sparing effect,
      antihyperalgesic property and potentialization of the neuromuscular blocker agent effect. On
      the other hand there has been a growing concern related to opioid administration, such as
      hyperalgesia, delayed return of intestinal function and the (still controversial) possibility
      of facilitating effect on tumor growth and metastases in cancer patients.

      This project is based on a previous randomized, double blind prospective trial (conducted by
      one of these authors and not yet published) comparing two groups of patients who received
      general intravenous total anesthesia with propofol in controlled target infusion.

      The surgical stress index is obtained by the interaction between the interval between heart
      beats and the amplitude of the photoplethysmography wave, whose algorithm generates a number
      related to the hemodynamic result of the increase of the sympathetic tone, which has shown to
      be the most sensitive resource in detecting the imbalance between the stimulus nociceptive
      and anti-nociception.

      Objectives The main objective of this project is to evaluate the feasibility of the use of
      magnesium sulfate in replacement of remifentanil as the main analgesic agent in total venous
      general anesthesia in patients submitted to post-bariatric dermolipectomy surgery.

      The secondary objectives will be comparison of propofol consumption, time to onset of action,
      time of action and cisatracurium consumption between groups. We will evaluate pain scores in
      the immediate postoperative period and in the mornings and afternoons of the 3 days after
      surgery.
    

Intervention name(s): Remifentanil group; Magnesium sulfate group
Intervention type(s): Drug; Drug
Intervention description(s): Venous general anesthesia with propofol and remifentanil.; Venous general anesthesia with propofol and magnesium sulfate
Intervention MeSH terms: Magnesium Sulfate; Remifentanil
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Prospective, controlled, randomized and double-blind clinical trial.
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Postoperative pain; opioid; Postoperative analgesia