Comparison of the Efficacy of Fentanyl and a Paracetamol–Magnesium Combination in Attenuating Hemodynamic Response to Sternotomy in Patients Undergoing CABG

Introduction: Fentanyl is commonly used to attenuate hemodynamic responses during cardiac surgery but is associated with adverse effects. Paracetamol and magnesium sulfate offer a potential opioid-sparing alternative. This study compared the efficacy of fentanyl versus a paracetamol-magnesium combination in controlling intraoperative hemodynamic changes and postoperative pain. Materials and Methods: In this prospective comparative study, 90 adult patients undergoing elective cardiac surgery via median sternotomy were randomized into two groups: Group F (fentanyl) and Group PM (paracetamol 15 mg/kg + magnesium sulfate 30 mg/kg). Hemodynamic parameters (SBP, DBP, MAP, HR) were recorded perioperatively. Postoperative pain (VAS scores), morphine consumption, and extubation time were assessed. Statistical analysis was performed with p < 0.05 considered significant. Results: Baseline characteristics were similar. Group PM had significantly lower SBP at 4 and 5 minutes post-sternotomy (p=0.041, p=0.031). DBP and MAP were also lower in Group PM from 1 minute onward (p < 0.05). At 24 hours, 80% of Group PM had minimal pain (VAS 1) versus 24.4% in Group F. Morphine usage was comparable (p=0.904). Extubation was earlier in Group PM, though not statistically significant. Conclusion: Paracetamol-magnesium provided better hemodynamic control and postoperative analgesia without delaying extubation. It is a safe and effective alternative to fentanyl in cardiac anesthesia.