الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
O
ne of the primary aims of anesthesia is to alleviate the patient’s pain and agony, by permitting the performance of surgical procedures without any discomfort. Relief of postoperative pain has gained real importance in recent years considering the central, peripheral and immunological stress response to tissue injury. Any expertise acquired in this field should be extended into the postoperative period, which is the period of severe, intolerable pain requiring attention. So there is a need for extended analgesia without any side effects to achieve this goal.
The use of opioids in intrathecal or epidural anesthesia has become popular to optimize postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use.
Several investigations have shown that intrathecal or epidural administration of opioids produces a dose dependent modulation of spinal nociceptive processing in animals and humans and is not associated with sedation.
The purpose of this study was to assess the postoperative analgesic requirements and the analgesic effect of adding magnesium sulphate to epidural bupivacaine compared to addition of fentanyl in patients undergoing lower limb orthopedic surgery under combined spinal epidural anathesia
Sixty patients came to Demerdash Hospital for lower limb orthopedic surgery, They were randomly allocated into two equal groups (30 patients) group A and group B.
group (A): Bupivacaine-magnesium sulfate
▪ Patients received magnesium sulphate (75 mg) added to 10 ml bupivacaine 0.25% in epidural
group (B): Bupivacaine-Fentanyl
▪ Patients received fentanyl (1mcg/kg) added to 10 ml bupivacaine 0.25% in epidural
All patients were assessed and monitored for: Hemodynamic: ECG for heart rate, and non-invasive arterial pressure, respiratory rate and arterial oxygen saturation, onset of sensory block, duration of analgesia, intra operative analgesia, post operative analgesia, time of first analgesic requirements, adverse effects as: hypotension, bradycardia, respiratory depression, urinary retention, pruritus, shivering, nausea and vomiting were recorded.