Comparison of Intravenous Magnesium Sulphate Combined with Acetaminophen Versus Intravenous Nalbuphine in Chronic Obstructive Pulmonary Disease Patients Undergoing Elective Cholecystectomy

Objective: To compare the analgesic efficacy of non-opioid anesthesia (NOA) using intravenous Magnesium Sulphate combined with intravenous Acetaminophen versus intravenous Nalbuphine in COPD (chronic obstructive pulmonary disease) patients undergoing elective laparoscopic cholecystectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Rawalpindi Pakistan, from Aug 2023 to Feb 2024. Methodology: Primary variables measured were per-operative mean heart rate, mean arterial pressure, time to rescue analgesia and median pain scores at 1-, 3- and 6-hour intervals. Secondary variables were the incidence of hypotension, respiratory depression, nausea and vomiting between both groups. Results: When observing the primary variables, mean time to first dose of rescue analgesia required was 122.49±14.01 minutes in Group-M versus 151.71±10.36 minutes in Group-N (p<0.001). When comparing the post-operative median pain scores, median pain score at 1 hour post-operatively was 3.00 (IQR=1.00) in Group- M versus 2.00 (IQR=1.00) in Group-N (p=0.353). Scores observed 3 hours post-operatively were 3.00 (IQR=0.00) versus 3.00 (IQR=0.00) between Group-M and Group-N (p=0.626). Finally, median pain scores 6 hours post-operatively showed 3.00 (IQR=0.00) versus 3.00 (IQR=0.00) between both groups respectively (p=0.154). Conclusion: We conclude that intravenous Magnesium Sulphate with Acetaminophen is a good alternative and provides superior adverse effect profile than Nalbuphine in patients with COPD.