Non-Opioidal Management of Perioperative Hemodynamics and Postoperative Pain in Laparoscopy- Role of Magnesium Sulphate and Clonidine

Background: Laparoscopic cholecystectomy has become one of the most commonly performed abdominal surgery throughout the world. Major hemodynamic perturbations encountered during the creation of pneumoperitoneum for laparoscopy have an impact on peri-operative outcomes. In the present era of opioid crisis, a non-opioidal approach to address the peri-operative management is the need of the day. Methods: A prospective randomized double-blinded study was conducted on 90 patients with ASA grade 1 and 2 and undergoing elective laparoscopic cholecystectomy under general anaesthesia. Patients were randomly assigned to receive either MgSO4 (elemental Magnesium 50mg/kg), clonidine 2 micrograms/kg or normal saline (NS) prior to induction and evaluated for hemodynamic responses to pneumoperitoneum; surgical field clarity using Fromme-Boezaart and VAS score and post-operative pain using VAS scores. Data was compared using Oneway ANOVA, Kruskal-Wallis and Chi-Square tests. Results: Clonidine was found to be superior to MgSO4 in attenuating the rise in heart rate and blood pressure following pneumoperitoneum. However, the surgical field clarity was similarly superior to control in both MgSO4 and Clonidine groups. Post-operatively, the time to rescue analgesia was more with MgSO4 while the VAS score was less as compared to control. Conclusion: Both Magnesium sulphate and Clonidine given prior to the induction of anesthesia in laparoscopic surgery effectively attenuated the hemodynamic response to laryngoscopy and pneumoperitoneum, provided a clear surgical field as well as provided good post-operative analgesia. However, between the two, attenuation of hemodynamic response was better with clonidine whereas, Magnesium sulphate provided a better post-operative analgesia. The surgical field clarity was equal with both the drugs. In the present era of opioid epidemic, it becomes imperative that pain management be revamped and wherever possible be replaced by non-opioidal drugs.