Effects of Magnesium Sulfate on Postoperative Pain and Complications after General Anesthesia: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YIN Xiuru ,  PEI Ling

Department of Anesthesiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China;

Corresponding?author：

PEI Ling, Email: lingpei49@vip.sina.com

Keywords：

Magnesium sulfate; Pain; General anesthesia; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20120054

Video：

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Objective　 To systematically evaluate the effects of magnesium sulfate on postoperative pain and complications after general anesthesia.
Methods　 A literature search was conducted in following databases as The Cochrane Library, EMbase, PubMed, EBSCO, Springer, Ovid, CNKI and CBM from the date of establishment to September 2011 to identify randomized controlled trials (RCTs) about intravenous infusion of magnesium sulfate during general anesthesia. All included RCTs were assessed and the data were extracted according to the standard of Cochrane systematic review. The homogenous studies were pooled using RevMan 5.1 software.
Results　 A total of 11 RCTs involving 905 patients were included. The results of meta-analyses showed that compared with the control group, intravenous infusion of magnesium sulfate during general anesthesia significantly reduced the visual analog scale (VAS) scores at the time-points of 2, 4, 6, 8, 16, and 24 hours, respectively, after surgery, the postoperative 24 hours morphine requirements, and the incidents of postoperative nausea and vomiting (RR=0.61, 95%CI 0.40 to 0.91, P=0.02) and chilling (RR=0.29, 95%CI 0.14 to 0.59, P=0.000 7). Although the incidents of bradycardia (RR=1.93, 95%CI 1.05 to 3.53, P=0.03) increased, there were no adverse events or significant differences in the incidents of hypotension and serum concentration changes of magnesium.
Conclusion　 Intravenous infusion of magnesium sulfate during general anesthesia may obviously decrease the pain intensity, and the incidents of nausea and vomiting and chilling after surgery, without increasing cardiovascular adverse events and risk of hypermagnesemia. The results still need to be confirmed by more high-quality and large-sample RCTs.

Citation： YIN Xiuru,PEI Ling. Effects of Magnesium Sulfate on Postoperative Pain and Complications after General Anesthesia: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2012, 12(3): 334-340. doi: 10.7507/1672-2531.20120054 Copy

1.	Soave PM, Conti G, Costa R, et al. Magnesium and anaesthesia. Current Drug Targets, 2009, 10(8): 734-743.
2.	Barbosa FT, Barbosa LT, Jucá MJ, et al. Applications of magnesium sulfate in obstetrics and anesthesia. Rev Bras Anestesiol, 2010, 60(1): 104-110.
3.	Ko SH, Lim HR, Kim DC, et al. Magnesium sulfate does not reduce postoperative analgesic requirements. Anesthesiology, 2001, 95(3): 640-646.
4.	Higgins JPT, Altman DG and Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from: www.cochrane-handbook.org.
5.	Kiran S, Gupta R, Verma D. Evaluation of a single-dose of intravenous magnesium sulphate for prevention of postoperative pain after inguinal surgery. Indian J Anaesth, 2011, 55(1): 31-35.
6.	Kaya S, Kararmaz A, Gedik R, et al. Magnesium sulfate reduces postoperative morphine requirement after remifentanil-based anesthesia. Med Sci Monit, 2009, 15(2): 15-19.
7.	Mentes O, Harlak A, Yigit T, et al. Effect of intraoperative magnesium sulphate infusion on pain relief after laparoscopic cholecystectomy. Acta Anaesthesiol Scand, 2008, 52(10): 1353-1359.
8.	Ferasatkish R, Dabbagh A, Alavi M, et al. Effect of magnesium sulfate on extubation time and acute pain in coronary artery bypass surgery. Acta Anaesthesiol Scand, 2008, 52(10): 1348-1352.
9.	Ryu JH, Kang MH, Park KS, et al. Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia. Br J Anaesth, 2008, 100(3): 397-403.
10.	Tramèr MR, Glynn CJ. An evaluation of a single dose of magnesium to supplement analgesia after ambulatory surgery: randomized controlled trial. Anesth Analg, 2007, 104(6): 1374-1379.
11.	Cizmeci P, Ozkose Z. Magnesium sulphate as an adjuvant to total intravenous anesthesia in septorhinoplasty: a randomized controlled study. Aesthetic Plast Surg, 2007, 31(2): 167-173.
12.	Tauzin-Fin P, Sesay M, Delort-Laval S, et al. Intravenous magnesium sulphate decreases postoperative tramadol requirement after radical prostatectomy. Eur J Anaesthesiol, 2006, 23(12): 1055-1059.
13.	Bhatia A, Kashyap L, Pawar DK, et al. Effect of intraoperative magnesium infusion on perioperative analgesia in open cholecystectomy. J Clin Anesth, 2004, 16(4): 262-265.
14.	Levaux Ch, Bonhomme V, Dewandre PY, et al. Effect of intra-operative magnesium sulphate on pain relief and patient comfort after major lumbar orthopaedic surgery. Anaesthesia, 2003, 58(2): 131-135.
15.	譚天云, 胡興國, 肖亞芬, 等. 硫酸鎂對腹腔鏡膽囊摘除術術后疼痛的影響. 醫學臨床研究, 2006, 23(12): 1922-1924.
16.	Hollmann MW, Liu HT, Hoenemann CW, et al. Modulation of NMDA receptor function by ketamine and magnesium.Part II: interactions with volatile anesthetics. Anesth Analg, 2001, 92(5): 1182-1191.
17.	Kara H, Sahin N, Ulusan V, et al. Magnesium infusion reduces perioperative pain. Eur J Anaesthesiol, 2002, 19(1): 52-56.
18.	Telci L, Esen F, Akcora D, et al. Evaluation of effects of magnesium sulphate in reducing intraoperative anaesthetic requirements. Br J Anaesth, 2002, 89(4): 594-598.
19.	Oguzhan N, Gunday I, Turan A. Effect of magnesium sulfate infusion on sevoflurane consumption, hemodynamics, and perioperative opioid consumption in lumbar disc surgery. J Opioid Manag, 2008, 4(2): 105-110.
20.	Zarauza R, Sáez-Fernández AN, Iribarren M, et al. A comparative study with oral nifedipine, intravenous nimodipine, and magnesium sulfate in postoperative analgesia. Anesth Analg, 2000, 91(4): 938-943.
21.	Schulz-Stübner S, Wettmann G, Reyle-Hahn SM, et al. Magnesium as part of balanced general anaesthesia with propofol, remifentanil and mivacurium: a double-blind, randomized prospective study in 50 patients. Eur J Anaesthesiol, 2001, 18(11): 723-729.
22.	Dubé L, Granry JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anesth, 2003, 50(7): 732- 746.
23.	Ryu JH, Sohn IS, Do SH. Controlled hypotension for middle ear surgery: a comparison between remifentanil and magnesium sulphate. Br J Anaesth, 2009, 103(4): 490-495.
24.	Parra L, Fita G, Gomar C, et al. Plasma magnesium in patients submitted to cardiac surgery and its influence on perioperative morbidity. J Cardiovasc Surg (Torino), 2001, 42(1): 37-42.

1. Soave PM, Conti G, Costa R, et al. Magnesium and anaesthesia. Current Drug Targets, 2009, 10(8): 734-743.
2. Barbosa FT, Barbosa LT, Jucá MJ, et al. Applications of magnesium sulfate in obstetrics and anesthesia. Rev Bras Anestesiol, 2010, 60(1): 104-110.
3. Ko SH, Lim HR, Kim DC, et al. Magnesium sulfate does not reduce postoperative analgesic requirements. Anesthesiology, 2001, 95(3): 640-646.
4. Higgins JPT, Altman DG and Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from: www.cochrane-handbook.org.
5. Kiran S, Gupta R, Verma D. Evaluation of a single-dose of intravenous magnesium sulphate for prevention of postoperative pain after inguinal surgery. Indian J Anaesth, 2011, 55(1): 31-35.
6. Kaya S, Kararmaz A, Gedik R, et al. Magnesium sulfate reduces postoperative morphine requirement after remifentanil-based anesthesia. Med Sci Monit, 2009, 15(2): 15-19.
7. Mentes O, Harlak A, Yigit T, et al. Effect of intraoperative magnesium sulphate infusion on pain relief after laparoscopic cholecystectomy. Acta Anaesthesiol Scand, 2008, 52(10): 1353-1359.
8. Ferasatkish R, Dabbagh A, Alavi M, et al. Effect of magnesium sulfate on extubation time and acute pain in coronary artery bypass surgery. Acta Anaesthesiol Scand, 2008, 52(10): 1348-1352.
9. Ryu JH, Kang MH, Park KS, et al. Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia. Br J Anaesth, 2008, 100(3): 397-403.
10. Tramèr MR, Glynn CJ. An evaluation of a single dose of magnesium to supplement analgesia after ambulatory surgery: randomized controlled trial. Anesth Analg, 2007, 104(6): 1374-1379.
11. Cizmeci P, Ozkose Z. Magnesium sulphate as an adjuvant to total intravenous anesthesia in septorhinoplasty: a randomized controlled study. Aesthetic Plast Surg, 2007, 31(2): 167-173.
12. Tauzin-Fin P, Sesay M, Delort-Laval S, et al. Intravenous magnesium sulphate decreases postoperative tramadol requirement after radical prostatectomy. Eur J Anaesthesiol, 2006, 23(12): 1055-1059.
13. Bhatia A, Kashyap L, Pawar DK, et al. Effect of intraoperative magnesium infusion on perioperative analgesia in open cholecystectomy. J Clin Anesth, 2004, 16(4): 262-265.
14. Levaux Ch, Bonhomme V, Dewandre PY, et al. Effect of intra-operative magnesium sulphate on pain relief and patient comfort after major lumbar orthopaedic surgery. Anaesthesia, 2003, 58(2): 131-135.
15. 譚天云, 胡興國, 肖亞芬, 等. 硫酸鎂對腹腔鏡膽囊摘除術術后疼痛的影響. 醫學臨床研究, 2006, 23(12): 1922-1924.
16. Hollmann MW, Liu HT, Hoenemann CW, et al. Modulation of NMDA receptor function by ketamine and magnesium.Part II: interactions with volatile anesthetics. Anesth Analg, 2001, 92(5): 1182-1191.
17. Kara H, Sahin N, Ulusan V, et al. Magnesium infusion reduces perioperative pain. Eur J Anaesthesiol, 2002, 19(1): 52-56.
18. Telci L, Esen F, Akcora D, et al. Evaluation of effects of magnesium sulphate in reducing intraoperative anaesthetic requirements. Br J Anaesth, 2002, 89(4): 594-598.
19. Oguzhan N, Gunday I, Turan A. Effect of magnesium sulfate infusion on sevoflurane consumption, hemodynamics, and perioperative opioid consumption in lumbar disc surgery. J Opioid Manag, 2008, 4(2): 105-110.
20. Zarauza R, Sáez-Fernández AN, Iribarren M, et al. A comparative study with oral nifedipine, intravenous nimodipine, and magnesium sulfate in postoperative analgesia. Anesth Analg, 2000, 91(4): 938-943.
21. Schulz-Stübner S, Wettmann G, Reyle-Hahn SM, et al. Magnesium as part of balanced general anaesthesia with propofol, remifentanil and mivacurium: a double-blind, randomized prospective study in 50 patients. Eur J Anaesthesiol, 2001, 18(11): 723-729.
22. Dubé L, Granry JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anesth, 2003, 50(7): 732- 746.
23. Ryu JH, Sohn IS, Do SH. Controlled hypotension for middle ear surgery: a comparison between remifentanil and magnesium sulphate. Br J Anaesth, 2009, 103(4): 490-495.
24. Parra L, Fita G, Gomar C, et al. Plasma magnesium in patients submitted to cardiac surgery and its influence on perioperative morbidity. J Cardiovasc Surg (Torino), 2001, 42(1): 37-42.

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Effects of Magnesium Sulfate on Postoperative Pain and Complications after General Anesthesia: A Meta-Analysis

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