A comparison of pre-procedure magnesium sulphate and fentanyl citrate for total intravenous anesthesia with propofol in patients undergoing intracavitary brachytherapy for carcinoma of cervix

Abstract

Aims and objectives: Intracavitary radiotherapy (ICR) is a form of brachytherapy used in treatment of early or locally confined cervical cancer. This study was undertaken to study the comparison of combination of intravenous Inj. magnesium sulphate and Inj. propofol with Inj. fentanyl citrate and Inj.propofol in patients undergoing intracavitary brachytherapy for locally confined carcinoma of cervix under total intravenous anesthesia. Material and method: Fifty patients belonging to ASA I and ASA II were randomly divided into two groups. Group M received i.v magnesium sulphate 30mg/kg, ten minutes before procedure and group F received i.v fentanyl citrate 1µg/kg ten minutes before procedure. Group M received Magnesium sulphate 10mg/kg/hr by continuous i.v infusion during the procedure. Group F received same amount of isotonic saline. For induction injection propofol, 1-2mg/kg was given intravenously. Anaesthesia was maintained with i.v. propofol 1mg/kg as and when required in incremental doses. We monitored pulse, blood pressure, ECG and SPO2 at preprocedure, during procedure, at the end of procedure, 5mins, 10 mins and 30 mins in recovery room. Patients were observed for nausea, vomiting, sedation, shivering and visual analogue scale score for measurement of severity of pain. We observed total amount of propofol required during the procedure. Results: The total amount of propofol required in group M(130±19.09mg) was less as compared to group F (172.8±29.09mg).That was statistically significant(P=0.0187). Both the groups were similar in hemodynamic stability in terms of systolic and diastolic blood pressures, mean arterial pressure and heart rate throughout the procedure. Postoperative visual analogue scale score and satisfaction score were similar in both groups. Sedation score was higher in group F as compared to group M (P <0.05).Incidence of nausea, vomiting, shivering were less in group M as compared to group F. Conclusion: Preoperative administration of i.v. magnesium sulphate reduces propofol requirement and reduces incidence of nausea, vomiting, shivering and sedation in post-operative period. Hence magnesium sulphate can be used in place of fentanyl citrate, where fentanyl citrate is contraindicated.