Perioperative Magnesium Sulfate As an Adjuvant in Anesthesia: A Systematic Review and Meta-Analysis

Abstract

Background: Optimized perioperative pain control is crucial for anesthesia practice and perioperative pain itself is related to post-operative morbidity and prologed use of opioids and their side effects. Magnesium sulfate as adjunct to anesthesia owing to N-methyl-D-aspartate receptor antagonism and calcium channel blocking activity, is increasingly studied for its efficacy on anesthetic and perioperative pain management. The objective of this systematic review and meta-analysis was to assess the effectiveness and safety of perioperative magnesium sulfate as adjunct in anesthesia and perioperative pain control.

Methods: A comprehensive search of PubMed MEDLINE Scopus, Google Scholar and Cochrane Library databases was performed to identify randomized controlled trials evaluating perioperative magnesium sulfate administration on postoperative pain in patients undergoing various surgical procedures. The trials included intravenous intrathecal epidural or regional administration of magnesium sulfate, and documented pain scores. The measures of pain intensity, opioid consumption, duration of analgesia and anesthetic requirements, were evaluated plus any adverse events that were reported. The risk of bias for all studies was assessed using standard criteria.

Results: Eight randomized controlled trials with a total of 684 patients were included in this analysis. Perioperative magnesium sulfate infusion resulted in a significant decrease in postoperative pain scores at both 6 and 24 hours compared to the various control groups. The mean Visual Analog Scale pain scores was A lot less with magnesium sulfate infusion (pooled MeanDifference 2.1 at 6 hours and 1.8 at 24 hours). Patients receiving magnesium sulfate infusion also had a significant decrease in total post-operative opioid requirements, a prolonged duration of post-operative analgesia, and delayed requirement for rescue analgesics. There was also a benefit to patients receiving magnesium sulfate infusion based upon the time to requirement of rescue analgesics following injection with various routes of supplementation: intravenous, neuraxial, and peripheral nerve block. Aside from few transient side effects like hypotension and flushing, serious side effects were not common.

Conclusion: Perioperative magnesium sulfate has proven itself to be an effective and acceptable anesthetic adjuvant in a number of different surgical procedures. Magnesium sulfate has been found to afford Really better postoperative analgesia, with decreased opioid consumption and increased analgesic duration compared to control groups. Magnesium sulfate has a sound opioid-sparing effect and a safe side effect profile, encouraging its use in a number of different multimodal perioperative analgesic regimens. Further large, randomized controlled studies are warranted to determine the optimal dose for magnesium sulfate and its most appropriate clinical applications.