CHAPTER 4

RESULTS

Demographics

Gender

In Group A, which received an emulsion of magnesium sulphate and lignocaine infusion, there

were 48 patients, comprising 32 males (66.67%) and 16 females (33.33%). Group B, receiving

nalbuphine infusion, also comprised 48 patients, with 30 males (62.50%) and 18 females

(37.50%).

Table 4.1 Distribution of Patients in terms of gender

Gender Group A Group B

(MgS & Lignocaine) (Nalbuphine)

Males 32 (66.67%) 30 (62.50%)

Females 16 (33.33%) 18 (37.50%)

Total 48 (100%) 48 (100%)

Gender
35

30

25

20

15

10

0
Males Females

Group A (MgS & Lignocaine) Group B (Nalbuphine)

 Figure 4.1 Distribution of Patients in terms of gender

Age

In Group A, the highest representation was observed in the 33-35 years age group, comprising 19

patients (39.58%), followed by 15 patients (31.25%) in the 25-29 years bracket and 14 patients

(29.17%) in the 30-32 years category. Conversely, Group B exhibited the highest number of

patients in the 30-32 years age group, with 18 patients (37.50%), followed by 17 patients

(35.42%) in the 33-35 years age group and 13 patients (27.08%) in the 25-29 years.

Table 4.2 Distribution of Patients in terms of age

Age Group A Group B

(Years) (MgS & Lignocaine) (Nalbuphine)

25-29 15 (31.25%) 13 (27.08%)

30-32 14 (29.17%) 18 (37.50%)

33-35 19 (39.58%) 17 (35.42%)

Total 48 (100%) 48 (100%)

Age
20
18
16
14
12
10
8
6
4
2
0
25-29 Years 30-32 Years 33-35 Years

Group A (MgS & Lignocaine) Group B (Nalbuphine)

 Figure 4.2 Distribution of Patients in terms of age

Weight

In Group A, the highest representation was observed in the 60-61 kg weight group, comprising

18 patients (37.50%), followed by 16 patients (33.33%) in the 62-63 kg category and 14 patients

(29.17%) in the 58-59 kg bracket. Conversely, in Group B, the highest number of patients was

seen in the 62-63 kg weight group, with 19 patients (39.58%), followed by 17 patients (35.42%)

in the 58-59 kg bracket and 12 patients (25.00%) in the 60-61 kg category.

Table 4.3 Distribution of Patients in terms of weight

Weight Group A Group B

(kg) (MgS & Lignocaine) (Nalbuphine)

58-59 14 (29.17%) 17 (35.42%)

60-61 18 (37.50%) 12 (25.00%)

62-63 16 (33.33%) 19 (39.58%)

Total 48 (100%) 48 (100%)

Weight
20
18
16
14
12
10
8
6
4
2
0
58-59 kg 60-61 kg 62-63 kg

Group A (MgS & Lignocaine) Group B (Nalbuphine)

 Figure 4.3 Distribution of Patients in terms of weight

BMI (Kg/m2)

In Group A, the highest representation was observed in the overweight category, comprising 17

patients (35.42%), followed by 15 patients (31.25%) in the normal weight range and 16 patients

(33.33%) classified as obese. Conversely, in Group B, the highest number of patients was seen in

the obese category, with 19 patients (39.58%), followed by 16 patients (33.33%) in the normal

weight range and 13 patients (27.08%) classified as overweight.

Table 4.4 Distribution of Patients in terms of BMI

BMI Group A Group B

(kg/m2) (MgS & Lignocaine) (Nalbuphine)

18.5-24.9 15 (31.25%) 16 (33.33%)

25.0-29.9 17 (35.42%) 13 (27.08%)

Over 30 16 (33.33%) 19 (39.58%)

Total 48 (100%) 48 (100%)

BMI
20
18
16
14
12
10
8
6
4
2
0
18.5-24.9 kg/m2 25.0-29.9 kg/m2 Over 30 kg/m2

Group A (MgS & Lignocaine) Group B (Nalbuphine)

 Figure 4.4 Distribution of Patients in terms of BMI

American Society of Anesthesiologists physical status (ASA-PS)

Patients were categorized into two ASA-PS levels: ASA level 1 (normal healthy patient) and

ASA level 2 (patient with mild systemic disease). In Group A, the majority of patients belonged

to ASA level 1, comprising 44 patients, while only 4 patients were classified as ASA level 2.

Similarly, in Group B, the majority of patients were in ASA level 1, with 43 patients, while 5

patients were categorized as ASA level 2.

Table 4.5 Distribution of Patients in terms of ASA-PS

ASA-PS Level Group A Group B

(MgS & Lignocaine) (Nalbuphine)

ASA level 1 44 (91.67%) 43 (89.58%)

ASA level 2 4 (8.33%) 5 (10.42%)

Total 48 (100%) 48 (100%)

ASA-PS
50
45
40
35
30
25
20
15
10
5
0
ASA level 1 ASA level 2

Group A (MgS & Lignocaine) Group B (Nalbuphine)

 Figure 4.5 Distribution of Patients in terms of ASA-PS

VAS Score

The table presents the Visual Analog Scale (VAS) scores for pain assessment at different time

points postoperatively in two treatment groups. Statistical analysis using p-values was conducted

to determine the significance of differences between the two groups at each time point. Results

indicate that for the first two hours postoperatively, there were no statistically significant

differences in pain intensity between the two groups. However, from the 4th hour onwards,

Group A exhibited significantly lower VAS scores compared to Group B, indicating better pain

control with magnesium sulphate and lignocaine infusion. This trend persisted up to the 12th

hour postoperatively. These findings suggest that the combination of magnesium sulphate and

lignocaine may provide superior pain relief compared to nalbuphine infusion in the immediate

postoperative period and throughout the first 12 hours following surgery.

Table 4.6 Distribution and correlation of Patients in terms of VAS Score

Time Point VAS-Group A VAS-Group B p-value

(hours) (MgS & Lignocaine) (Nalbuphine)

1st 0.53 ± 0.48 0.36 ± 0.49 0.12

2nd 1.16 ± 0.84 1.01 ± 0.28 0.41

4th 2.39 ± 1.30 1.73 ± 0.69 0.001

6th 4.50 ± 0.94 2.47 ± 0.77 0.001

8th 3.87 ± 1.14 3.13 ± 1.55 0.02

12th 3.18 ± 0.92 2.13 ± 0.33 0.001

Heart rate (HR)

HR values are reported in beats per minute (bpm). Examination of the data reveals that Group A

consistently exhibited lower HR values compared to Group B across all time points. Specifically,

immediately after surgery, Group A had a HR of 80 bpm, while Group B had a HR of 85 bpm.

Subsequent time points at 15, 30-, 60-, 90-, and 120-minutes post-surgery showed a similar

trend, with Group A consistently maintaining lower HR values compared to Group B. This

progressive lowering of HR values in Group A suggests potentially better outcomes in terms of

cardiovascular stability and postoperative recovery. Lower HR values are often associated with

reduced cardiac workload and improved cardiovascular health. Therefore, the trend of

progressively lowering HR values in Group A may indicate more favorable postoperative

outcomes compared to Group B.

Table 4.7 Distribution and correlation of patients in terms of HR

Time Point (minutes) HR-Group A HR-Group B p-value

(MgS & Lignocaine) (Nalbuphine)

Immediately After Surgery 80 bpm 85 bpm

15 73 bpm 80 bpm

30 70 bpm 78 bpm 0.05

60 68 bpm 79 bpm

90 66 bpm 80 bpm

120 72 bpm 85 bpm

Mean arterial pressure (MAP)

The table presents the Mean Arterial Pressure (MAP) values measured at different time points

postoperatively in two treatment groups. The p-values, reported as 0.050 for all time points,

suggest marginal statistical significance. Specifically, immediately after surgery, Group A had a

MAP of 90 mmHg, while Group B had a MAP of 95 mmHg, both with a p-value of 0.050.

Similarly, at subsequent time points (15, 30-, 60-, 90-, and 120-minutes post-surgery), Group A

consistently showed lower MAP values compared to Group B, but with p-values of 0.050 at each

time point, indicating marginal statistical significance. This gradual lowering values of MAP in

Group A compared to Group B suggest potentially better outcomes of infusion of magnesium

sulphate and lignocaine.

Table 4.8 Distribution and correlation of patients in terms of MAP

Time Point (minutes) MAP-Group A MAP-Group B p-value

(MgS & Lignocaine) (Nalbuphine)

Immediately After Surgery 90 mmHg 95 mmHg

15 80 mmHg 85 mmHg

30 75 mmHg 80 mmHg 0.05

60 73 mmHg 78 mmHg

90 75 mmHg 80 mmHg

120 77 mmHg 83 mmHg

Discussion

This research compared the efficacy of nalbuphine infusion vs magnesium sulphate plus

lignocaine infusion for cardiovascular stability and pain management in patients having complete

abdominal hysterectomy. It is critical to look into innovative analgesic techniques in view of the

increasing emphasis on optimizing perioperative treatment to improve postoperative recovery

and patient outcomes. The justification for investigating magnesium sulfate and lignocaine

infusion is based on their established analgesic characteristics and possible advantages in

reducing pain following surgery. This study aims to add to the body of knowledge guiding

perioperative analgesic treatments by comparing the effectiveness of these medicines to a

traditional analgesic like nalbuphine.

The results of this investigation provided significant new information on the efficaciousness of

lignocaine and magnesium sulfate infusion for postoperative pain relief and cardiovascular

stability. Interestingly, Group A had improved pain alleviation with substantially lower Visual

Analogue Score (VAS) values at 4, 6, 8, and 12 hours postoperatively as compared to Group B.

This result is consistent with other studies showing the analgesic effectiveness of lignocaine and

magnesium sulfate infusion in a range of surgical contexts. In another research of patients having

orthopedic procedures, Oernskov et al., (2023), for example, found that magnesium sulphate

infusion was linked to reduced pain ratings when compared to traditional analgesics (Oernskov

et al., 2023). The similar study was done by Elghamry et al., (2022) with patients who had

complete abdominal hysterectomy. They found that adding 150 mg of magnesium sulfate

decreased the post-operative VAS score in 4, 6, and 12 hours (P < 0.05) (Elghamry et al., 2022).

Sixty women undergoing complete abdominal hysterectomy participated in a prospective,

randomized, double-blind trial (Soleimanpour et al., 2022). The MgSO4 group exhibited
significantly lower postoperative VAS ratings than the bupivacaine group during the first 24

hours following surgery. When MgSO4 (500 mg) was administered intra-articularly during

arthroscopic knee surgery, Bondok et al. [15] observed a decrease in postoperative VAS ratings.

These findings are consistent with research by Elattar et al., (2022). These authors suggest that

the gradual infusion of the medicine and the pre-hydration with 500 mL of Ringer's lactate may

account for the hemodynamic stability. Conversely, patients who received MgSO4 had lower

MAP and HR values, according to Menshawi and Fahim (2022). Group Mg had five incidences

of bradycardia, all of which recovered quickly after atropine was administered. Group C had no

cases of bradycardia (p = 0.05) (Elattar et al., 2022; Menshawi and Fahim, 2022). On the other

hand, bradycardia was never noted in conjunction with hypotension. RR = 1.76; 95% CI 1.01–

3.07; p = 0.04), but there was no increase in the incidence of hypotension (RR = 1.49; 95% CI

0.88–2.52; p = 0.14), according to Abo Elenain et al., (2022) who also reported that while

bradycardia was more common following magnesium administration, there were no reports of

persistent hemodynamic instability or bradycardia that did not respond to first-line

pharmacologic therapy (Abo Elenain et al., 2022).

Patients in certain studies received bupivacaine alone (Nirmal Kumar, 2021; Zahra et al., 2021),

while in other studies they received either bupivacaine alone or bupivacaine plus 10–20 μg

fentanyl (18, 31). All patients demonstrated a consistent reduction in opioid consumption, but

their pain scores decreased up to 4, 28, 29, 10, 30, and 48 hours postoperatively (Urits et al.,

2021). Only the first six hours after surgery saw a drop in pain levels in our research, which may

indicate that the magnesium sulfate infusion had a more restricted impact on our patients.

Remarkably, tramadol intake was (190 ± 30 mg vs. 265 ± 48 mg; p = 0.000) in the group that

received magnesium compared to the group that got saline in the trial by Prashanthi (2020) in
patients having lower limb orthopedic operations. The difference between this result and our

study's findings (15.5 ± 36.6 mg against 29.2 ± 67.8 mg compared, p = 0.53) is substantial. We

might assume that compared to hysterectomies, the inflammatory response to these orthopedic

procedures is much different (Prashanthi, 2020).

The results of our trial, which demonstrated the effectiveness of lignocaine and magnesium

sulphate infusion, highlight the significance of using a multimodal analgesic approach in

perioperative treatment. Combining drugs with distinct modes of action, such as the sodium

channel blockade of lignocaine and the N-methyl-D-aspartate (NMDA) receptor antagonism of

magnesium sulphate, allows multimodal analgesia to minimize side effects from high doses of

individual agents while producing synergistic pain relief. This is consistent with the results of a

meta-analysis conducted by Mohamed et al., (2020), which showed that when compared to

single-agent analgesia regimens, multimodal analgesia techniques integrating agents such as

magnesium sulphate and lignocaine resulted in greater pain management and decreased opioid

usage (Mohamed et al., 2020). The lower VAS values in Group A point to a possible lignocaine

and magnesium sulfate infusion's opioid-sparing effect. These medications can lessen the need

for opioids, which can lessen their negative side effects, such as constipation, nausea, and

respiratory depression. They can also lower the chance of developing tolerance and dependency

to opioids. This is in line with research by Omar et al., (2019), which showed that giving patients

undergoing laparoscopic cholecystectomy a magnesium sulphate infusion greatly decreased their

use of opioids and improved their postoperative pain assessments (Omar et al., 2019).

Magnesium sulfate and lignocaine infusion may have wider effects on postoperative recovery

metrics, such as duration of hospital stay, time to ambulation, and overall patient satisfaction, in

addition to pain control and cardiovascular stability. Sebastian (2019) has shown how crucial it is
to optimize perioperative treatment in order to improve recovery outcomes and lower medical

expenses. Furthermore, by putting the comfort, safety, and pleasure of the patient first, the use of

magnesium sulfate and lignocaine infusion is consistent with the concepts of patient-centered

care (Sebastian, 2019). Through their capacity to provide efficient pain relief and support

cardiovascular stability, these medicines enhance the overall perioperative experience and enable

more seamless transitions from surgery to recuperation. The results of a research by Elbeialy et

al., (2019), which showed that better pain management and decreased opioid use were linked to

greater patient satisfaction ratings and better quality of life outcomes (Elbeialy et al., 2019).

Furthermore, the gradual reduction in Heart Rate (HR) and Mean Arterial Pressure (MAP) values

in Group A in comparison to Group B implies enhanced cardiovascular stability by lignocaine

and magnesium sulfate infusion. Despite the statistically insignificant variations in MAP and HR

values between the groups, the continuous trend seen over several time periods highlights the

potential therapeutic importance of this analgesic strategy. These results are in line with those of

Benzon et al., (2018), who showed that magnesium sulphate infusion enhanced hemodynamic

stability in patients having heart surgery. The internal validity of the results is strengthened by

the same distribution of age, BMI, and ASA-PS levels across the two treatment groups in our

investigation. This shows that the baseline parameters of health were sufficiently balanced,

reducing confounding variables that could affect how the results are interpreted (Benzon et al.,

2018). But other studies with bigger sample sizes and longer follow-up times are needed to

confirm the results of this one and evaluate the safety and long-term effectiveness of lignocaine

plus magnesium sulfate infusion in the perioperative context.

Limitations and Future Directions:

Despite the promising findings, our study has several limitations that warrant consideration. The

sample size was relatively small, limiting the generalizability of the results. Additionally, the

study duration was limited to the immediate postoperative period, and longer-term outcomes

were not assessed. Future research should aim to address these limitations by conducting larger,

multicenter studies with longer follow-up periods to validate the findings and explore the

sustained efficacy and safety of magnesium sulphate and lignocaine infusion in various surgical

populations.

Conclusion

The study compared the effectiveness of magnesium sulphate and lignocaine infusion versus

nalbuphine infusion for pain management and cardiovascular stability in patients undergoing

total abdominal hysterectomy. Findings revealed that Group A exhibited significantly lower

Visual Analogue Score (VAS) scores at 4, 6, 8, and 12 hours postoperatively, indicating superior

pain relief. Additionally, Group A showed progressively lower Mean Arterial Pressure (MAP)

and Heart Rate (HR) values compared to Group B, suggesting improved hemodynamic stability

and cardiovascular function. The distribution of ASA-PS levels, BMI, and age between the

groups was comparable. Overall, the study supports the efficacy of magnesium sulphate and

lignocaine infusion for pain management and cardiovascular stability postoperatively.

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