Por qué la infusión preventiva de una dosis baja de sulfato de magnesio influye en la percepción del dolor postoperatorio y el nivel sérico de beta-endorfinas en las histerectomías abdominales totales / Whether preventive low dose magnesium sulphate infusion has an influence on postoperative pain perception and the level of serum beta-endorphin throughout the total abdominal hysterectomy

Objetivo. Debido al conocido papel preventivo que juegan las bajas dosis de sulfato de magnesio en el tratamiento del dolor postoperatorio, en este estudio aleatorizado a doble ciego y controlado con placebo tratamos de investigar la posible relación entre la infusión intraoperatoria de sulfato de magnesio, la analgesia postoperatoria y el nivel de beta-endorfinas séricas en las histerectomías abdominales totales realizadas bajo anestesia general. Métodos. Se distribuyó aleatoriamente a 40 mujeres sometidas a histerectomía abdominal total en 2 grupos (20 en cada uno de ellos). Quince minutos antes de la inducción de anestesia, al grupo de estudio se le administró una infusión intravenosa de sulfato de magnesio (15mg/kg/h), y al grupo control con placebo se le administró el mismo volumen de solución salina isotónica. Las puntuaciones del dolor se evaluaron a las 0, 6, 12 y 24h posteriores a la intervención, utilizando la escala de calificación numérica verbal. Se registró de manera precisa el consumo de petidina. Se determinó el nivel sérico de beta-endorfinas 15min antes de la inducción y al finalizar las intervenciones, utilizando el método ELISA. Resultados. A las 6 y 12h posteriores a las intervenciones, el valor de la escala de calificación numérica verbal en el grupo de estudio fue considerablemente menor que en el grupo control con placebo (p=0,0001). A las 24h de la intervención, el consumo de petidina fue significativamente inferior en el grupo de estudio en comparación con el grupo control (p=0,0001). En el grupo de estudio, el nivel sérico de beta-endorfinas descendió considerablemente al final de las intervenciones, en comparación con el momento anterior a la inducción (p=0,04). Conclusión. Demostramos que la baja dosis preventiva e intraoperatoria de sulfato de magnesio reduce el dolor postoperatorio, tiene un efecto opioide moderado y disminuye la concentración sérica de beta-endorfinas en las histerectomías abdominales totales (AU)

Objective. Due to the known role of preventive low dose magnesium sulphate on postoperative pain management, in this randomized, double-blinded, placebo-controlled study, we tried to investigate the possible relationship between low dose intra-operative magnesium sulphate infusion, postoperative analgesia and the level of serum beta-endorphin during total abdominal hysterectomy under general anesthesia. Methods. Forty women undergoing total abdominal hysterectomy were randomly allocated into 2 groups (20 in each arm). Fifteen minutes before induction of anaesthesia, the case group received a continuous intravenous infusion of magnesium sulphate (15mg/kg/h) and placebo control group received the same volume of isotonic saline. Pain scores were assessed at 0, 6, 12, and 24h after operations using Verbal Numeric Rating Scale. Pethidine consumption was recorded precisely. Serum level of beta-endorphin just 15min before the induction and at the end of the operations was determined by ELISA technique. Results. At 6 and 12h after the operations, Verbal Numeric Rating Scale in the case group was significantly lower than that of placebo control group (P=.0001). Over 24h after the operations, pethidine consumption was significantly lower in the case group compared with control group (P=.0001). In the case group, serum level of beta-endorphin was significantly decreased at the end of the operations compared with before the induction (P=.04). Conclusion. We illustrated that preventive low dose intra-operative magnesium sulphate infusion reduces postoperative pain, has opioid sparing effect and declines serum beta-endorphin concentration during total abdominal hysterectomy (AU)

Whether preventive low dose magnesium sulphate infusion has an influence on postoperative pain perception and the level of serum beta-endorphin throughout the total abdominal hysterectomy. / Por qué la infusión preventiva de una dosis baja de sulfato de magnesio influye en la percepción del dolor postoperatorio y el nivel sérico de beta-endorfinas en las histerectomías abdominales totales.

OBJECTIVE: Due to the known role of preventive low dose magnesium sulphate on postoperative pain management, in this randomized, double-blinded, placebo-controlled study, we tried to investigate the possible relationship between low dose intra-operative magnesium sulphate infusion, postoperative analgesia and the level of serum beta-endorphin during total abdominal hysterectomy under general anesthesia. METHODS: Forty women undergoing total abdominal hysterectomy were randomly allocated into 2 groups (20 in each arm). Fifteen minutes before induction of anaesthesia, the case group received a continuous intravenous infusion of magnesium sulphate (15mg/kg/h) and placebo control group received the same volume of isotonic saline. Pain scores were assessed at 0, 6, 12, and 24h after operations using Verbal Numeric Rating Scale. Pethidine consumption was recorded precisely. Serum level of beta-endorphin just 15min before the induction and at the end of the operations was determined by ELISA technique. RESULTS: At 6 and 12h after the operations, Verbal Numeric Rating Scale in the case group was significantly lower than that of placebo control group (P=.0001). Over 24h after the operations, pethidine consumption was significantly lower in the case group compared with control group (P=.0001). In the case group, serum level of beta-endorphin was significantly decreased at the end of the operations compared with before the induction (P=.04). CONCLUSION: We illustrated that preventive low dose intra-operative magnesium sulphate infusion reduces postoperative pain, has opioid sparing effect and declines serum beta-endorphin concentration during total abdominal hysterectomy.

Acute reversible renal failure in a patient with paroxysmal nocturnal hemoglobinuria.

We present the case of a young male with 2-month history of intermittent upper abdominal pain who developed diarrhea, anorexia, tea-color urine, and decreased urine output. He was found to be in severe acute renal failure requiring hemodialysis, four sessions in 10-day period. By the end of the second week of hospitalization renal function gradually improved with total recovery of function to a baseline creatinine of 1.1 mg/dl 25 days after the diagnosis of acute renal failure. His workup included Ham's test, water sugar test, and RBC fragility test which confirmed the diagnosis of paroxysmal nocturnal hemoglobinuria.