الفهرس 
Evaluation of the analgesic effect of magnesium sulphate versus fentanyl as adjuvants to epidural levobupivacaine in elderly undergoing lumbar spine surgery
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Abstract
Noxious stimuli release excitatory neurotransmitters such as glutamate and aspartate, which bind to various receptors including N-methyl-D-aspartate (NMDA) receptors. Magnesium is a NMDA antagonist and has antinociceptive effects in animal and human models of pain. The addition of magnesium to perioperative epidural infusion may decrease postoperative pain and requirement of opioids especially in elderly in whom intravenous opioids are not considered the best choice. 66 patients above 65 years old scheduled for single level lumbar spine surgery in neurosurgical theatre in Cairo university hospital were blindly randomized into three groups and subjected to a comparative study; group A, group B or group C. group A received epidural bolus of 14 ml levobupivacaine0.5%+1ml saline followed by epidural infusion of levobupivacaine.0.125%, group B received 14ml levobupivacaine0.5% +50 mg magnesium sulphate in 1ml saline followed by epidural infusion of levobupivacaine 0.125%+2mg/ml magnesium sulfate, and group C received 14ml levobupivacaine 0.5% + 50 microgram fentanyl followed by epidural infusion of levobupivacaine 0.125%+4 microgram/ml fentanyl. The epidural infusion continued till the end of the surgery at a rate 5ml / hr. Perioperative hemodynamics, time taken till complete sensory and motor block, pain assessment using visual analogue scale (VAS), post operative sedation and post operative complications were assessed and recorded