Effect Of Intravenous Application Of Magnesium Sulfate On Postoperative Pain In Patients Undergoing Laparoscopic Cholecystectomy

Objective:To observe whether intravenous application of magnesium sulfate has analgesic effect after laparoscopic cholecystectomy,so as to improve postoperative pain and promote early recovery of patientsMethods:Sixty patients who underwent elective laparoscopic cholecystectomy from the First Affiliated Hospital of Dali University from June 2022 to December 2022were selected and randomly divided into magnesium sulfate group（MgSO4 group）and normal saline group（NS group）,with 30 cases in each group.In MgSO4 group,5%magnesium sulfate was injected intravenously at a loading dose of 40mg/kg 30min before anesthesia induction,and 5%magnesium sulfate was pumped continuously at10mg/kg/h until gallbladder was removed.NS group was replaced with the same amount of normal saline.Anesthesia induction:Sufentanil 0.5ug/kg,propofol 1%2.0mg/kg,cis-atracurium 0.2mg/kg.Anesthesia maintenance:propofol 4-6mg/kg/h,inhalation of sevoflurane 1-2%.Sevoflurane and propofol were stopped after the gallbladder was removed.Neostigmine and atropine were used to antagonize muscle relaxations after suture.Pain scores of Digital Rating Scale（NRS）were recorded at 1h,4h,8h,12h,24h and 48h after surgery.The number of analgesic relief cases was recorded;The incidence of nausea,vomiting,urinary retention,chills and respiratory depression were observed within 48h after operation.SBP,DBP,MAP,and HR were recorded at 10min rest（T0）,after loading experimental drugs（T1）,immediately after intubation（T2）,1min after pneumoperitoneum establishment（T3）,10min after pneumoperitoneum establishment（T4）,and 20min after pneumoperitoneum establishment（T5）.Record the time from discontinuation of maintenance drugs and experimental drugs to tracheal catheter extraction;The incidence of intraoperative hypotension and bradycardia was observed.The duration of operation was recorded,i.e.the time from the end of skin incision to the end of skin suture.Record the time from discontinuation of maintenance drugs and experimental drugs to tracheal catheter extraction;Serum Mg2+concentration was measured before operation and one day after operation.Results:Between groups:there were no significant differences in gender,age,body mass index（BMI）,ASA grading and operation duration between two groups（P>0.05）.The NRS score of MgSO₄group was lower than that of NS group after surgery and 1h,4h,8h and 12h after surgery,with statistical significance（P<0.05）,but there was no statistical difference between the two groups in NRS score at 24h and 48h after surgery（P>0.05）.There was no significant difference in the number of postoperative analgesic relief cases between the two groups（P>0.05）.There was no significant difference in the incidence of nausea,vomiting,urinary retention and shivering between NS group and MgSO₄group 48 hours after surgery（P>0.05）,and no respiratory depression occurred between the two groups 48 hours after surgery.There were no significant differences in SBP,DBP and HR between the two groups after 10min rest（T0）at home invasion（P>0.05）.MAP and HR in MgSO₄group were lower than those in NS group after intubation（T2）and 1min（T3）,10min（T4）and 20min（T5）after pneumoperitoneum establishment.The difference was statistically significant（P<0.05）.There was no significant difference between the two groups in SBP and DBP at T4 and DBP at T5（P>0.05）.The extubation time of MgSO₄group was longer than that of NS group from discontinuation of anesthetic maintenance drugs and experimental drugs to extubation time,and the difference was statistically significant（P<0.05）.There was no significant difference in the incidence of bradycardia and hypotension between the two groups（P>0.05）.There was no significant difference in serum Mg2+concentration between the two groups before surgery（P>0.05）.In the group:After loading（T1）,SBP,DBP and HR in MgSO₄group were lower than those in T0 group,and the difference was statistically significant（P<0.05）.The serum Mg²⁺concentration in the NS group after surgery and one day after surgery was decreased compared with that before surgery,and the difference was statistically significant（P<0.05）.The serum Mg²⁺concentration in the MgSO₄group before surgery was（0.82±0.04）mmol/L,increased to（1.27±0.05）mmol/L after surgery,and was（0.84±0.06）mmol/L one day after surgery.The difference was statistically significant（P<0.05）.Conclusions:In laparoscopic cholecystectomy,intravenous application of magnesium sulfate can reduce postoperative pain,make intraoperative hemodynamics more stable,and does not increase the incidence of central vascular adverse events and postoperative adverse reactions.In the perioperative period,attention should be paid to the serum Mg²⁺concentration of patients,and keeping the appropriate serum Mg²⁺is conducive to ensuring the safety of the perioperative period.