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REGIONAL ANESTHESIA AND PAIN MEDICINE

A Comparative Study with Oral Nifedipine, Intravenous Nimodipine, and Magnesium Sulfate in Postoperative Analgesia

Department of Anesthesiology and Critical Care, School of Medicine, University of Navarra, Pamplona, Spain

Address correspondence and reprint requests to Rosina Zarauza, MD, PhD, Department of Anesthesiology and Critical Care, School of Medicine, University of Navarra, E-31080 Pamplona, Spain. Address e-mail to rzarauza{at}unav.es

We tested the ability of two L-type calcium channel blockers (nifedipine and nimodipine) and the N-methyl D-aspartate natural antagonist magnesium to decrease morphine requirements and pain in the postoperative period in 92 patients undergoing elective colorectal surgery. In a randomized, double-blinded study, patients were assigned to one of four groups. The control group received placebo. The nifedipine group received 60 mg of oral nifedipine. The magnesium group received an initial dose of 30 mg/kg followed by 10 mg · kg^-1 · h^-1 of magnesium sulfate over 20 h. The nimodipine group received 30 µg · kg^-1 · h^-1 of nimodipine over 20 h. Postoperative morphine consumption was assessed for 48 h. Pain at rest and pain on movement were assessed up to the fifth day postsurgery. There were no differences among groups in postoperative morphine consumption at 12 and 24 h. The nifedipine group consumed more morphine than the control and nimodipine groups during 24–48 h. Pain at rest scores were higher at 16 and 24 h in the nifedipine group than in the other three groups. Pain on movement scores were lower at 72 h in the nimodipine group than in the control and nifedipine groups. In conclusion, the perioperative application of oral nifedipine, IV nimodipine, or IV magnesium sulfate failed to decrease postoperative morphine requirements after colorectal surgery.

Implications: The increase of intracellular calcium plays a key role in spinal transmission of pain and in the establishment of central sensitization. We examined the effects of nifedipine, nimodipine, and magnesium sulfate in postoperative analgesia after colorectal surgery. We found no differences in morphine consumption with the administration of each drug alone.

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				M. R. Tramer and C. J. Glynn An Evaluation of a Single Dose of Magnesium to Supplement Analgesia After Ambulatory Surgery: Randomized Controlled Trial Anesth. Analg., June 1, 2007; 104(6): 1374 - 1379. [Abstract] [Full Text] [PDF]

				C. Lysakowski, L. Dumont, C. Czarnetzki, and M. R. Tramer Magnesium as an Adjuvant to Postoperative Analgesia: A Systematic Review of Randomized Trials Anesth. Analg., June 1, 2007; 104(6): 1532 - 1539. [Abstract] [Full Text] [PDF]

				G. Casey, S.-A. Nortcliffe, P. Sharpe, and D. J. Buggy Perioperative Nimodipine and Postoperative Analgesia Anesth. Analg., February 1, 2006; 102(2): 504 - 508. [Abstract] [Full Text] [PDF]

				C. J. L. McCartney, A. Sinha, and J. Katz A Qualitative Systematic Review of the Role of N-Methyl-D-Aspartate Receptor Antagonists in Preventive Analgesia Anesth. Analg., May 1, 2004; 98(5): 1385 - 1400. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999