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Tavanaei R, Rezaee-Naserabad SS, Alizadeh S, Yazdani KO, Zali A, Farsani HA, Oraee-Yazdani S. Analgesic Effects of Preoperative Combination of Oral Pregabalin and Intravenous Magnesium Sulfate on Postoperative Pain in Patients Undergoing Posterolateral Spinal Fusion Surgery: A 4-arm, Randomized, Double-blind, Placebo-controlled Trial. J Neurosurg Anesthesiol 2024; 36:134-141. [PMID: 36603131 DOI: 10.1097/ana.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/31/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Multimodal perioperative pain management including nonopioid analgesia is a major pillar of enhanced recovery after surgery programs. The aim of this study was to investigate the analgesic efficacy of the preoperative combination of 2 nonopioid drugs, oral pregabalin and intravenous magnesium sulfate, in patients undergoing posterolateral lumbar spinal fusion. METHODS This 4-arm, randomized, double-blind, placebo-controlled trial included 104 patients randomly allocated to receive: magnesium sulfate and pregabalin (MP), magnesium sulfate and oral placebo (M), 0.9% saline and oral pregabalin (P), and 0.9% saline and oral placebo (C). The study drugs were administered 1 hour preoperatively. The primary outcome was the cumulative morphine consumption on postoperative day 1. Secondary outcomes included visual analog scale scores for leg pain at rest and with movement, and postoperative nausea and vomiting (PONV) in the first 48 hours after surgery. RESULTS Cumulative morphine consumption on postoperative day 1 was lower in group MP (19.6±8.0 mg) compared with group M (32.6±9.5 mg; P <0.001), group P (28.9±9.4 mg; P =0.001), or group C (38.8±10.3 mg; P <0.001). Multiple linear regression demonstrated a significant association between group MP and cumulative morphine consumption (B=-5.4 [95% CI, -7.1, -3.7], P <0.001). Visual analog scale scores for leg pain at rest and with movement were lower in group MP compared with other groups ( P =0.006 and <0.001). The incidence of PONV was also lowest in group MP ( P =0.032). CONCLUSIONS Preoperative administration of oral pregabalin and intravenous magnesium sulfate resulted in reduced morphine consumption and greater analgesic effect than the use of each drug individually or placebo in patients undergoing posterolateral lumbar spinal fusion.
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Affiliation(s)
- Roozbeh Tavanaei
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences
| | - Seyyed S Rezaee-Naserabad
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences
| | - Sajjad Alizadeh
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences
| | - Kaveh O Yazdani
- Department of Cardiovascular Diseases, Zahedan University of Medical Science, Zahedan, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences
| | - Hamidreza A Farsani
- Department of Anesthesiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran
| | - Saeed Oraee-Yazdani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences
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Xu H, Hao C, Wang X, Du J, Zhang T, Zhang X. Effect of Intraoperative infusion Magnesium Sulfate Infusion on Postoperative Quality of Recovery in Patients Undergoing Total Knee Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Trial. Drug Des Devel Ther 2024; 18:919-929. [PMID: 38560523 PMCID: PMC10980840 DOI: 10.2147/dddt.s444896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
Background Magnesium sulfate, an intravenous adjuvant, has recently attracted immense attention in multimodal analgesia. Previous studies confirmed the crucial role of magnesium sulfate in postoperative pain and nociceptive hypersensitivity. However, the effect of magnesium sulfate in multimodal analgesia on the quality of recovery (QoR) for elderly patients has not been thoroughly studied. Therefore, the present experiment aimed to investigate the effect of continuous intravenous magnesium sulfate on the quality of postoperative recovery in elderly patients undergoing total knee arthroplasty (TKA). Patients and Methods In this study, a total of 148 patients scheduled to undergo unilateral total knee arthroplasty were randomized into a magnesium sulfate group (Group M, n=68) and a control group (Group C, n=66) using a double-blind, randomized controlled trial. Before induction of anesthesia, Group M received intravenous magnesium sulfate (40 mg/kg) for 15 min, followed by a continuous infusion (15 mg/kg) until the end of the procedure. In the same manner, Group C received an infusion of the same amount of isotonic saline using the same method as the Group M. Results Compared with Group C, Group M had significantly better QoR-15 scores on postoperative day 1(POD1) than Group C (P <0.05). Analysis of the dimensions of QoR-15 scores indicated that Group M exhibited notably reduced levels of pain, and higher levels of emotional state and physical comfort than Group C (P <0.05). Furthermore, Group C had significantly higher numerical rating scale (NRS) scores at POD1 than Group M (P <0.05). Conclusion For elderly patients undergoing knee arthroplasty, magnesium sulfate can be used as an adjuvant in a multimodal analgesic regimen to reduce early postoperative pain and improve the quality of early postoperative recovery.
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Affiliation(s)
- Hai Xu
- Department of Anesthesiology, Graduate Training Base of Lianyungang First People’s Hospital of Jinzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
| | - Conghui Hao
- Department of Anesthesiology, Graduate Training Base of Lianyungang First People’s Hospital of Jinzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
| | - Xinxin Wang
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
| | - Jingjing Du
- Department of Anesthesiology, Graduate Training Base of Lianyungang First People’s Hospital of Jinzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
| | - Tianyu Zhang
- Department of Anesthesiology, Graduate Training Base of Lianyungang First People’s Hospital of Jinzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
| | - Xiaobao Zhang
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, People’s Republic of China
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Puch Oernskov M, Gaspar Santos S, Sohail Asghar M, Wildgaard K. Is intravenous magnesium sulphate a suitable adjuvant in postoperative pain management? - A critical and systematic review of methodology in randomized controlled trials. Scand J Pain 2023; 23:251-267. [PMID: 36473053 DOI: 10.1515/sjpain-2022-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022]
Abstract
A growing worldwide focus on opioid-free anaesthesia entails multimodal analgesic strategies involving non-opioids such as magnesium sulphate (MgSO4). Several systematic reviews have concluded there is beneficial analgesic effect of MgSO4 administration but do not take considerable heterogeneity among the studies into consideration. Medical literature published until June 2021 was searched in PubMed/Medline, Embase, Central and Web of Science: The final search yielded a total of 5,672 articles. We included only randomised controlled trials assessing the effect of intravenous MgSO4 on opioid consumption and acute postoperative pain when compared to either placebo or standardized analgesic treatment. The primary aim was to compare the homogeneity of essential variables and confounders. A post-hoc meta-analysis demonstrated a reduction in both postoperative morphine consumption (-6.12 mg) and pain score (-12.32 VAS points) in favour of the MgSO4-groups. Data for meta-analysis was missing from 19 studies (45%) on morphine consumption and 29 studies (69%) for pain score, the majority of which reports no effect for either morphine consumption or pain score. The calculated heterogeneity among the included studies was considerable for both outcomes; I 2=91% for morphine consumption and I 2=96% for pain score. Although we found a per se reduction in opioid consumption and pain score, methodological heterogeneity and clinical shortcomings of pre-, intra-, and post anaesthetic data precludes conclusions on clinical importance of intraoperative intravenous MgSO4. In addition, the reduction is likely less than what can be gained from using standardized analgesic treatment.
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Affiliation(s)
- Mark Puch Oernskov
- Department of Anaesthesia, Pain and Respiratory Support, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | | | | | - Kim Wildgaard
- Department of Anaesthesiology and Herlev Anaesthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
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Wang Q, Dong J, Ye X, Ren YF. A Meta-Analysis Showing the Quantitative Evidence Base of Preemptive Pregabalin for Postoperative Pain from Cancer-Related Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:280. [PMID: 36837482 PMCID: PMC9965191 DOI: 10.3390/medicina59020280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/14/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
Background and Objectives: As an adjunct to postoperative multimodal analgesic regimens, pregabalin has been reported in reducing postoperative acute pain and opioid consumption. However, there is only a small amount of evidence for preemptive pregabalin in patients undergoing cancer-related surgery. This systematic review was conducted to integrate high-quality evidence to evaluate the preemptive analgesic effects of pregabalin in cancer-related surgery. Materials and Methods: Seven electronic databases were searched in a combination of subject terms and free words. Efficacy and safety of preemptive pregabalin on postoperative pain for cancer-related surgery were evaluated by assessing resting and dynamic pain scores postoperatively, cumulative morphine equivalent consumption, time to first analgesic request, hemodynamic parameters, and the safety indicators. Results: Thirteen trials were incorporated for quantitative synthesis. The pooled results showed administration of pregabalin preoperatively is clinically significant for improving resting (weighted mean difference (WMD), -1.53 cm; 95% CI, -2.30 to -0.77) and dynamic (WMD, -1.16 cm; 95% CI, -2.22 to -0.11) pain severity scores at 2 h postoperatively and prolonging time to first analgesic request (WMD, 2.28 h; 95% CI, 0.79 to 3.77) in cancer-related surgery. Preemptive pregabalin was also statistically effective in some other pain indicators but would increase the risk of pregabalin-related side effects after surgery. Conclusions: Our findings do not support the administration of pregabalin in doses larger than 300 mg when put in cancer-related surgery. Taken together, more high-quality research particularly focused on the optimal dosages and timing of pregabalin in cancer-related surgery is needed in the future to establish stronger evidence for therapeutic effects.
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Affiliation(s)
| | | | - Xin Ye
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
| | - Yi-Feng Ren
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China
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Hall EA, Brandon HH, Jasmin HM, Raghavan KC, Anghelescu DL. Perioperative Indications for Gabapentinoids in Pediatrics: A Narrative Review. Paediatr Drugs 2023; 25:43-66. [PMID: 36434428 PMCID: PMC9836387 DOI: 10.1007/s40272-022-00545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/26/2022]
Abstract
In recent years, there has been increased interest in using gabapentinoids (gabapentin and pregabalin) as part of multimodal medication plans or enhanced recovery after surgery protocols to mitigate several perioperative clinical challenges. Outcomes explored in the context of using gabapentinoids perioperatively in children are variable and include acute complications of pain, anxiety, nausea and vomiting, and emergence agitation, as well as the long-term postoperative outcome of chronic postsurgical pain. This narrative review describes the current literature regarding perioperative use of gabapentinoids in pediatric patients and aims to describe the role of gabapentinoids in the perioperative setting for each specific indication.
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Affiliation(s)
- Elizabeth A Hall
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
| | - Hope H Brandon
- University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
| | - Hilary M Jasmin
- Health Sciences Library, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kavitha C Raghavan
- Anesthesiology Division, Pediatric Medicine Department, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Doralina L Anghelescu
- Anesthesiology Division, Pediatric Medicine Department, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Coccolini F, Corradi F, Sartelli M, Coimbra R, Kryvoruchko IA, Leppaniemi A, Doklestic K, Bignami E, Biancofiore G, Bala M, Marco C, Damaskos D, Biffl WL, Fugazzola P, Santonastaso D, Agnoletti V, Sbarbaro C, Nacoti M, Hardcastle TC, Mariani D, De Simone B, Tolonen M, Ball C, Podda M, Di Carlo I, Di Saverio S, Navsaria P, Bonavina L, Abu-Zidan F, Soreide K, Fraga GP, Carvalho VH, Batista SF, Hecker A, Cucchetti A, Ercolani G, Tartaglia D, Galante JM, Wani I, Kurihara H, Tan E, Litvin A, Melotti RM, Sganga G, Zoro T, Isirdi A, De’Angelis N, Weber DG, Hodonou AM, tenBroek R, Parini D, Khan J, Sbrana G, Coniglio C, Giarratano A, Gratarola A, Zaghi C, Romeo O, Kelly M, Forfori F, Chiarugi M, Moore EE, Catena F, Malbrain MLNG. Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines. World J Emerg Surg 2022; 17:50. [PMID: 36131311 PMCID: PMC9494880 DOI: 10.1186/s13017-022-00455-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/16/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. MATERIAL AND METHODS An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. CONCLUSION Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | | | | | - Raul Coimbra
- Trauma Surgery Department, Riverside University Health System Medical Center, Loma Linda, CA USA
| | - Igor A. Kryvoruchko
- Department of Surgery No2, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Ari Leppaniemi
- General Surgery Department, Helsinki University Hospital, Helsinki, Finland
| | - Krstina Doklestic
- Clinic of Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Elena Bignami
- ICU Department, Parma University Hospital, Parma, Italy
| | | | - Miklosh Bala
- Trauma and Acute Care Surgery Unit Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Ceresoli Marco
- General Surgery Department, Monza University Hospital, Monza, Italy
| | - Dimitris Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Walt L. Biffl
- Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA USA
| | - Paola Fugazzola
- General Surgery Department, Pavia University Hospital, Pavia, Italy
| | | | | | | | - Mirco Nacoti
- ICU Department Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Timothy C. Hardcastle
- Trauma and Burn Service, Inkosi Albert Luthuli Central Hospital, Mayville, Durban, South Africa
| | - Diego Mariani
- General Surgery Department, Legnano Hospital, Legnano, Milano, Italy
| | - Belinda De Simone
- Emergency and Colorectal Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France
| | - Matti Tolonen
- Emergency Surgery, HUS Helsinki University Hospital, Meilahti Tower Hospital, Helsinki, Finland
| | - Chad Ball
- Trauma and Acute Care Surgery, Foothills Medical Center, Calgary, AB Canada
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | | | - Salomone Di Saverio
- General Surgery Department, San Benedetto del Tronto Hospital, San Benedetto del Tronto, Italy
| | - Pradeep Navsaria
- Trauma Center, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Luigi Bonavina
- General Surgery Department, San Donato Hospital, Milan, Italy
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway
| | - Gustavo P. Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | - Andreas Hecker
- General Surgery, Giessen University Hospital, Giessen, Germany
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences – DIMEC, Alma Mater Studiorum - University of Bologna, General Surgery of the Morgagni - Pierantoni Hospital, Forlì, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences – DIMEC, Alma Mater Studiorum - University of Bologna, General Surgery of the Morgagni - Pierantoni Hospital, Forlì, Italy
| | - Dario Tartaglia
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Joseph M. Galante
- General Surgery Department, UCLA Davis University Hospital, Los Angeles, CA USA
| | - Imtiaz Wani
- General Surgery Department, Government Gousiua Hospital, Srinagar, India
| | - Hayato Kurihara
- Emergency and Trauma Surgery Department, Milano University Hospital, Milan, Italy
| | - Edward Tan
- Emergency Department, Nijmegen Hospital, Nijmegen, The Netherlands
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia
| | | | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tamara Zoro
- ICU Department, Pisa University Hospital, Pisa, Italy
| | | | - Nicola De’Angelis
- Service de Chirurgie Digestive Et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France
| | - Dieter G. Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Adrien M. Hodonou
- Faculty of Medicine of Parakou, University of Parakou, Parakou, Benin
| | - Richard tenBroek
- General Surgery Department, Nijmegen Hospital, Nijmegen, The Netherlands
| | - Dario Parini
- General Surgery Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Jim Khan
- University of Portsmouth, Portsmouth Hospitals University NHS Trust UK, Portsmouth, UK
| | | | | | | | | | - Claudia Zaghi
- General, Emergency and Trauma Surgery Department, Vicenza Hospital, Vicenza, Italy
| | - Oreste Romeo
- Trauma and Surgical Critical Care, East Medical Center Drive, University of Michigan Health System, Ann Arbor, MI USA
| | - Michael Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | | | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | | | - Fausto Catena
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Manu L. N. G. Malbrain
- First Department Anaesthesiology Intensive Therapy, Medical University Lublin, Lublin, Poland
- International Fluid Academy, Lovenjoel, Belgium
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Soleimanpour H, Imani F, Dolati S, Soleimanpour M, Shahsavarinia K. Management of pain using magnesium sulphate: A narrative review. Postgrad Med 2022; 134:260-266. [PMID: 35086408 DOI: 10.1080/00325481.2022.2035092] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Pain is one of the most complex and unpleasant sensory and emotional human experiences. Pain relief continues to be a major medical challenge. The application of systemic opioid and regional analgesia techniques has facilitated a decrease in the occurrence and gravity of pain. Magnesium has an evolving role in pain management. Magnesium sulphate (MgSO4), the pharmacological form of magnesium, is a physiological voltage-dependent blocker of N-methyl-D-aspartate (NMDA)-coupled channels. In terms of its antinociceptive role, magnesium blocks calcium influx, which inhibits central sensitization and decreases preexisting pain hypersensitivity. These properties have encouraged the research of magnesium as an adjuvant agent for intra- and post-operative analgesia. Moreover, the mentioned magnesium impacts are also detected in patients with neuropathic pain. Intravenous magnesium sulphate, followed by a balanced analgesia, decreases opioid consumption. This review has focused on the existing evidence concerning the role of magnesium sulphate in pain management in situations including neuropathic pain, postherpetic neuralgia, trigeminal neuralgia, migraine, and post-operative pain. Additional studies are required to improve the use of magnesium sulphate for pain to increase the quality of life of patients.
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Affiliation(s)
- Hassan Soleimanpour
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sanam Dolati
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Soleimanpour
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Intravenously injected lidocaine or magnesium improves the quality of early recovery after laparoscopic cholecystectomy: A randomised controlled trial. Eur J Anaesthesiol 2021; 38:S1-S8. [PMID: 33074940 DOI: 10.1097/eja.0000000000001348] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previous data show that lidocaine or magnesium has unique characteristics of stress inhibition and antiinflammation. OBJECTIVE We aimed to observe the effects of lidocaine or magnesium on the quality of recovery (QoR) after laparoscopic cholecystectomy. DESIGN Single-centre, prospective, randomised, double-blind study. SETTING The Affiliated Hospital of Xuzhou Medical University from March 2019 to October 2019. PATIENTS One hundred and fourteen patients scheduled for laparoscopic cholecystectomy. INTERVENTION The enrolled patients were randomly divided into three groups. Lidocaine (group L), magnesium sulphate (group M) or 0.9% saline (group C) was administered intravenously 10 min before induction. MAIN OUTCOME MEASURES The quality of recovery 15 (QoR-15) score, the Hospital Anxiety and Depression Scale (HADS), and the Numerical Rating Scale (NRS) score were selected. The usage of propofol and remifentanil, haemodynamic parameters, anaesthesia recovery parameters and adverse events were also evaluated. RESULTS The QoR-15 scores for group L (132.0) and group M (134.0) were 6 and 8 points higher than that of group C (126.0) on POD1 (postoperative day 1) (adjP < 0.05). However, the decrease of QoR-15 in Group L is less than the minimal clinically important difference (8).The NRS scores on POD1 in group C 3, were higher than other two groups (adjP < 0.05). The dosage of remifentanil in group L was lower than other two groups (adjP < 0.05).The physical independence of group L and group M and physical comfort of group M were improved compared with group C. CONCLUSION The results show that magnesium sulphate improved the QoR through improving physical comfort and physical independence in patients after laparoscopic cholecystectomy. However, lidocaine had limited effects on QoR under current conditions. TRIAL REGISTRATION ChiCTR1800019092 (www.chictr.org.cn). CLINICAL TRIAL NUMBER AND REGISTRY URL The study was registered in the Chinese Clinical Trials Register (ChiCTR1800019092) https://www.chictr.org.cn.
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The effect of intravenous magnesium on postoperative morphine consumption in noncardiac surgery: A systematic review and meta-analysis with trial sequential analysis. Eur J Anaesthesiol 2021; 37:212-223. [PMID: 31977626 DOI: 10.1097/eja.0000000000001164] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several studies suggest that systemic magnesium reduces postoperative opioid consumption and the intensity of pain, but others report conflicting results. The efficacy and safety profile of intravenous magnesium in noncardiac surgery remain uncertain. OBJECTIVES The aim of this review was to investigate the effect of intravenous magnesium on the consumption of postoperative morphine in the first 24 h in adults undergoing noncardiac surgery. DESIGN Systematic review and meta-analysis with trial sequential analysis. DATA SOURCES MEDLINE, EMBASE, CENTRAL from their inception until January 2019. ELIGIBILITY CRITERIA All randomised clinical trials comparing intravenous magnesium versus placebo in noncardiac surgery were systematically searched in the databases. Observational studies, case reports, case series and nonsystematic reviews were excluded. RESULTS Fifty-one trials (n=3311) were included for quantitative meta-analysis. In comparison with placebo, postoperative morphine consumption at 24-h was significantly reduced in the magnesium group, with a mean difference [95% confidence interval (CI)] of -5.6 mg (-7.54 to -3.66, P < 0.001, I = 92%, level of evidence low). The trial sequential analysis for the effect of magnesium on postoperative morphine consumption was conclusive. Patients who received magnesium had a longer time to the first analgesia request [143 (103 to 183) min, P < 0.001, I = 99%, level of evidence low] and a lower incidence of shivering [0.26 (0.15 to 0.44), P < 0.001, I = 35%, level of evidence very low]. However, no significance differences were demonstrated in postoperative pain scores in the first 24 h (mean difference, 95% CI) -0.30 (-0.69 to 0.09, P = 0.13, I = 91%, level of evidence low), bradycardia (odds ratio, 95% CI) 1.13 (0.43 to 2.98, P = 0.80, I = 35%, level of evidence very low) and postoperative nausea and vomiting (odds ratio, 95% CI) 0.90 (0.67 to 1.22, P = 0.49, I = 25%, level of evidence moderate). CONCLUSION The current meta-analysis demonstrates that the use of intravenous magnesium as part of multimodal analgesia may reduce morphine consumption in the first 24 h after surgery and delay the time to the first request for analgesia in patients undergoing noncardiac surgery. However, the included studies were of low-quality with substantial heterogeneity. TRIAL REGISTRATION CRD42018086846.
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Chou AK, Chiu CC, Liu CC, Wang JJ, Chen YW, Hung CH. Pulsed Ultrasound Remedies Post-thoracotomy Hypersensitivity and Increases Spinal Anti-inflammatory Cytokine in Rats. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3296-3304. [PMID: 32891426 DOI: 10.1016/j.ultrasmedbio.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/20/2020] [Accepted: 08/02/2020] [Indexed: 02/07/2023]
Abstract
The purpose of the experiment was to study the effect of pulsed ultrasound (PUS) on post-thoracotomy pain and local tissue temperature and to correlate the findings with the alteration in spinal anti-inflammatory and pro-inflammatory cytokines. Mechanical sensitivity, subcutaneous temperature and spinal interleukin-10 (IL-10), IL-6 or tumor necrosis factor-alpha (TNF-α) expression were examined in a rat model of experimental post-thoracotomy pain. Group 1 received a sham surgery where thoracotomy was performed except for rib retraction. Group 2 underwent thoracotomy with rib retraction (TRR). Group 3 received the TRR procedure followed by PUS. Group 4 underwent the TRR procedure followed by only the massage with the ultrasound turned off. Compared with group 1 (sham), groups 2-4 showed a decrease in mechanical withdrawal thresholds on postoperative days (PODs) 10 and 11. On PODs 16, 23 and 30, group 3 (TRR+PUS-1) displayed an increase in mechanical withdrawal thresholds compared with groups 2 and 4. Subcutaneous and body temperatures in group 3 were not prominently different from group 1, group 2 (TRR only) or group 4 (TRR+PUS-0). Compared with group 2, group 3 had an increase in spinal IL-10 level on POD 30 and a decrease in spinal IL-6 or TNF-α expression on PODs 16 and 30. We concluded that mechanical hypersensitivity after TRR is postponed by PUS, and its effect continues for 3 wk. A PUS dose not increase local tissue temperature. The beneficial effect of PUS appears related to upregulation of spinal anti-inflammatory cytokine and downregulation of spinal pro-inflammatory cytokines.
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Affiliation(s)
- An-Kuo Chou
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan; Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chen-Chih Liu
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Allied AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Yu-Wen Chen
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Physical Therapy, College of Health Care, China Medical University, Taichung, Taiwan
| | - Ching-Hsia Hung
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Abstract
In terms of antinociceptive action, the main mode of action of magnesium involves its antagonist action at the N-methyl-d-aspartate (NMDA) receptor, which prevents central sensitization and attenuates preexisting pain hypersensitivity. Given the pivotal function of NMDA receptors in pain transduction, magnesium has been investigated in a variety of pain conditions. The oral and parenteral administration of magnesium via the intravenous, intrathecal, or epidural route may alleviate pain and perioperative anesthetic and analgesic requirements. These beneficial effects of magnesium therapy have also been reported in patients with neuropathic pain, such as malignancy-related neurologic symptoms, diabetic neuropathy, postherpetic neuralgia, and chemotherapy-induced peripheral neuropathy. In addition, magnesium treatment is reportedly able to alleviate fibromyalgia, dysmenorrhea, headaches, and acute migraine attacks. Although magnesium plays an evolving role in pain management, better understanding of the mechanism underlying its antinociceptive action and additional clinical studies is required to clarify its role as an adjuvant analgesic.
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Does diet play a role in reducing nociception related to inflammation and chronic pain? Nutrition 2019; 66:153-165. [DOI: 10.1016/j.nut.2019.04.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/22/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023]
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Oprea AD, Perrino AC, Popescu WM. Enhanced Recovery After Lung Surgery: Fad or Fashion? J Cardiothorac Vasc Anesth 2019; 33:2445-2447. [DOI: 10.1053/j.jvca.2019.03.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/31/2019] [Indexed: 11/11/2022]
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