Comparative study between effects of epidural magnesium sulphate on intraoperative and postoperative analgesic requirements in cancer thoracic surgery / Amr Mohmed Ahmed Saeed ; Supervised Abdelfattah Abdelsatar Hussein , Hossam Zarif Ghobrial , Mahmoud Ahmed Kamel

Thesis (Ph.D.) - Cairo University - National Cancer Institute - Department of Anesthesia Pain Relief

Thoracotomies were painful operations, & well-planned pain management was crucial in decreasing morbidity after major thoracic surgery for lung resection. TEA was usually preferred to IV analgesia for post-thoracotomy pain management. However, the first absolute contraindication for regional analgesia was refusal of the patient. Alternative methods were necessary to obtain analgesia in patients with other contraindications & in patients in whom a thoracic epidural cannot be placed. Systemic opioids were easy to use, cheap, & preferred by many clinicians. Adjuvant analgesics to opioids were being studied to decrease the required dose & the consequent unwarranted effects of opioids. Magnesium sulfate had been used for a long time in obstetric & cardiovascular practice. Noxious stimulation causes release of excitatory amino acids such as glutamate & aspartate. The actions of the excitatory amino acids were mediated by NMDA & non- NMDA receptors. Magnesium could modulate postoperative pain by preventing nociception associated with central sensitization via blockade of NMDA receptor calcium inophore. Magnesium inhibits calcium entry into the cell Via a noncompetitive blockade of the N-methyl-d-aspartate (NMDA) receptor. Magnesium & the NMDA receptor were thought to be involved in the modulation of pain. Magnesium was also a physiological calcium Tantagonist at different voltage-gated channels (which may be important in the mechanisms of antinociception ⁽¹{u⁰⁰B⁰}⁸⁾

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