The effects of perioperative low-dose magnesium sulfate infusion on postoperative pain in lumbar surgery

This paper aimed at evaluating the effect of low-dose perioperative magnesium sulfate (MgSO4) on postoperative pain in lumbar surgery. Sixty adult patients were included in this randomized controlled double-blind study. After intubation, an infusion of MgSO4 (10 mg/kg/h) and isotonic saline 0.9% (10 mg/kg/h) were administered in groups M and C, respectively. Heart rate and mean arterial pressure were recorded before and during surgery. Serum magnesium levels were recorded before and after the surgery. Perioperative remifentanil consumption and extubation time were recorded. In the post-anesthesia care room (PACU), Agitation-sedation with Richmond Agitation-Sedation Scale (RASS), the pain was evaluated with Visual Analogue Scale (VAS) and recorded at the baseline, at 5th, 10th, 15th and 30th minutes. Patients were transferred to surgical ward with intravenous patient-controlled analgesia (PCA) for postoperative analgesia and received diclofenac sodium for rescue analgesia if VAS >4. Postoperative VAS scores at 2nd, 4th, 6th and 24th hours, opioid consumption after 4 and 24 hours and rescue analgesic consumption for postoperative 24 h were recorded. In the PACU, RASS scores were statistically lower in group M than in group C (p = 0.001), and VAS scores were statistically lower at all measurement times in group M than in group C. In the surgical ward, VAS Scores were statistically lower in Group M at the 6th and 24th hours than in group C (p = 0.015, p = 0.009, respectively). The need for post-operative rescue analgesic was statistically lower in Group M (p < 0.001). The side effect incidence of both groups was similar. Our findings suggest that perioperative low-dose (10 mg/kg/h) MgSO4 infusion reduces early post-op agitation, VAS scores and the need for analgesics up to 24 hours postoperatively. Low dose MgSO4 infusion can be effectively applied for pain management in patients undergoing lumbar surgery.

Lumbar surgery; Magnesium sulfate; Pain; Visual analogue score

[1] Tsaousi G, Nikopoulou A, Pezikoglou I, Birba V, Grosomanidis V. Implementation of magnesium sulphate as an adjunct to multimodal analgesic approach for perioperative pain control in lumbar laminectomy surgery: a randomized placebo-controlled clinical trial. Clinical Neurology and Neurosurgery. 2020; 197: 106091.

[2] Debono B, Wainwright TW, Wang MY, Sigmundsson FG, Yang MMH, Smid-Nanninga H, et al. Consensus statement for perioperative care in lumbar spinal fusion: enhanced recovery after surgery (ERAS®) society recommendations. The Spine Journal. 2021; 21: 729–752.

[3] Ntalouka MP, Brotis AG, Bareka MV, Stertsou ES, Fountas KN, Arnaoutoglou EM. Multimodal analgesia in spine surgery: an umbrella review. World Neurosurgery. 2021; 149: 129–139.

[4] Yue L, Lin ZM, Mu GZ, Sun HL. Impact of intraoperative intravenous magnesium on spine surgery: a systematic review and meta-analysis of randomized controlled trials. eClinicalMedicine. 2022; 43: 101246.

[5] Choi GJ, Kim YI, Koo YH, Oh HC, Kang H. Perioperative magnesium for postoperative analgesia: an umbrella review of systematic reviews and updated meta-analysis of randomized controlled trials. Journal of Personalized Medicine. 2021; 11: 1273.

[6] Albrecht E, Kirkham KR, Liu SS, Brull R. Peri-operative intravenous administration of magnesium sulphate and operative pain: a meta-analysis. Anaesthesia. 2013; 68: 79–90.

[7] Ghaffaripour S, Mahmoudi H, Eghbal H, Rahimi A. The effect of intravenous magnesium sulfate on post-operative analgesia during laminectomy. Cureus. 2016; 8: e626.

[8] Soleimanpour H, Imani F, Dolati S, Soleimanpour M, Shahsavarinia K. Management of pain using magnesium sulphate: a narrative review. Postgraduate Medical Journal. 2022; 134: 260–266.

[9] Tramer MR, Schneider J, Marti R, Rifat K. Role of magnesium sulfate in postoperative analgesia. Anesthesiology. 1996; 84: 340–347.

[10] Levaux Ch, Bonhomme V, Dewandre PY, Brichant JF, Hans P. Effect of intra-operative magnesium sulphate on pain relief and patient comfort after major lumbar orthopaedic surgery. Anaesthesia. 2003; 58: 131–135.

[11] Dehkordy ME, Tavanaei R, Younesi E, Khorasanizade S, Farsani HA, Oraee-Yazdani S. Effects of perioperative magnesium sulfate infusion on intraoperative blood loss and postoperative analgesia in patients undergoing posterior lumbar spinal fusion surgery: a randomized controlled trial. Clinical Neurology and Neurosurgery. 2020; 196: 105983.

[12] Ghezel-Ahmadi V, Ghezel-Ahmadi D, Schirren J, Tsapopiorgas C, Beck G, Bölükbas S. Perioperative systemic magnesium sulphate to minimize acute and chronic post-thoracotomy pain: a prospective observational study. Journal of Thoracic Disease. 2019; 11: 418–426.

[13] Farouk I, Hassan MM, Fetouh AM, Elgayed AEA, Eldin MH, Abdelhamid BM. Analgesic and hemodynamic effects of intravenous infusion of magnesium sulphate versus dexmedetomidine in patients undergoing bilateral inguinal hernial surgeries under spinal anesthesia: a randomized controlled study. Brazilian Journal of Anesthesiology. 2021; 71: 489–497.

[14] Silva Filho SE, Sandes CS, Vieira JE, Cavalcanti IL. Analgesic effect of magnesium sulfate during total intravenous anesthesia: randomized clinical study. Brazilian Journal of Anesthesiology. 2021; 71: 550–557.

[15] Kiran S, Gupta R, Verma D. Evaluation of a single-dose of intravenous magnesium sulphate for prevention of postoperative pain after inguinal surgery. Indian Journal of Anaesthesia. 2011; 55: 31–35.

[16] Tochie JN, Bengono Bengono RS, Metogo JM, Ndikontar R, Ngouatna S, Ntock FN, et al. The efficacy and safety of an adapted opioid-free anesthesia regimen versus conventional general anesthesia in gynecological surgery for low-resource settings: a randomized pilot study. BMC Anesthesiology. 2022; 22: 325.

[17] Morel V, Pickering ME, Goubayon J, Djobo M, Macian N, Pickering G. Magnesium for pain treatment in 2021? State of the art. Nutrients. 2021; 13: 1397.

[18] Heidari B, Salimi R, Saremi H, Arab Ghahestani M. Assessment of magnesium sulfate infusion in combination with ketorolac for the pain management in intertrochanteric fractures; A randomized clinical trial. The Archives of Bone and Joint Surgery. 2023; 11: 414–420.

[19] Premkumar CR, Parthasarathy R, Kumar S, Vijaykumar S. Postoperative respiratory depression caused by iatrogenic hypermagnesaemia. Anaesthesia Reports. 2022; 10: e12154.