The effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic review
Background: This study evaluated the efficacy of epidurally administered magnesium associated with local anesthetics on postoperative pain control. Methods: The study protocol was registered in PROSPERO as CRD42021231910. Literature searches were conducted on Medline, Cochrane, EMBASE, CENTRAL, and...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-07-01
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| Series: | Brazilian Journal of Anesthesiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001422001063 |
| _version_ | 1797786590668390400 |
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| author | Getúlio Rodrigues de Oliveira Filho Adilto Mezzari Junior Giulia Nonticuri Bianchi |
| author_facet | Getúlio Rodrigues de Oliveira Filho Adilto Mezzari Junior Giulia Nonticuri Bianchi |
| author_sort | Getúlio Rodrigues de Oliveira Filho |
| collection | DOAJ |
| description | Background: This study evaluated the efficacy of epidurally administered magnesium associated with local anesthetics on postoperative pain control. Methods: The study protocol was registered in PROSPERO as CRD42021231910. Literature searches were conducted on Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing epidural administration of magnesium added to local anesthetics for postoperative pain in elective surgical adult patients. Primary outcomes were the time to the first Postoperative (PO) Analgesic Request (TFAR), 24-hour postoperative opioid consumption, and Visual Analog Scale (VAS) scores at the first six and 24 postoperative hours. Secondary outcomes included Postoperative Nausea and Vomiting (PONV), pruritus, and shivering. Quality of evidence was assessed using GRADE criteria. Results: Seventeen studies comparing epidural were included. Effect estimates are described as weighted Mean Differences (MD) and 95% Confidence Intervals (95% CI) for the main outcomes: TFAR (MD = 72.4 min; 95% CI = 10.22–134.58 min; p < 0.001; I2 = 99.8%; GRADE: very low); opioid consumption (MD = -7.2 mg (95% CI = -9.30 – -5.09; p < 0.001; I2 = 98%; GRADE: very low). VAS pain scores within the first six PO hours (VAS) (MD = -1.01 cm; 95% CI = -1.40–0.64 cm; p < 0.001; I2 = 88%; GRADE: very low), at 24 hours (MD = -0.56 cm; 95% CI = -1.14–0.01 cm; p = 0.05; I2 = 97%; GRADE: very low). Conclusions: Magnesium sulfate delayed TFAR and decreased 24-hour opioid consumption and early postoperative pain intensity. However, imprecision and inconsistency pervaded meta-analyses, causing very low certainty of effect estimates. |
| first_indexed | 2024-03-13T01:11:00Z |
| format | Article |
| id | doaj.art-b7a53a42ded1471997bc38bf489f8ff6 |
| institution | Directory Open Access Journal |
| issn | 0104-0014 |
| language | English |
| last_indexed | 2024-03-13T01:11:00Z |
| publishDate | 2023-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj.art-b7a53a42ded1471997bc38bf489f8ff62023-07-06T04:16:58ZengElsevierBrazilian Journal of Anesthesiology0104-00142023-07-01734455466The effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic reviewGetúlio Rodrigues de Oliveira Filho0Adilto Mezzari Junior1Giulia Nonticuri Bianchi2Corresponding author.; Universidade Federal de Santa Catarina, Departamento de Cirurgia, Florianópolis, SC, BrazilUniversidade Federal de Santa Catarina, Departamento de Cirurgia, Florianópolis, SC, BrazilUniversidade Federal de Santa Catarina, Departamento de Cirurgia, Florianópolis, SC, BrazilBackground: This study evaluated the efficacy of epidurally administered magnesium associated with local anesthetics on postoperative pain control. Methods: The study protocol was registered in PROSPERO as CRD42021231910. Literature searches were conducted on Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing epidural administration of magnesium added to local anesthetics for postoperative pain in elective surgical adult patients. Primary outcomes were the time to the first Postoperative (PO) Analgesic Request (TFAR), 24-hour postoperative opioid consumption, and Visual Analog Scale (VAS) scores at the first six and 24 postoperative hours. Secondary outcomes included Postoperative Nausea and Vomiting (PONV), pruritus, and shivering. Quality of evidence was assessed using GRADE criteria. Results: Seventeen studies comparing epidural were included. Effect estimates are described as weighted Mean Differences (MD) and 95% Confidence Intervals (95% CI) for the main outcomes: TFAR (MD = 72.4 min; 95% CI = 10.22–134.58 min; p < 0.001; I2 = 99.8%; GRADE: very low); opioid consumption (MD = -7.2 mg (95% CI = -9.30 – -5.09; p < 0.001; I2 = 98%; GRADE: very low). VAS pain scores within the first six PO hours (VAS) (MD = -1.01 cm; 95% CI = -1.40–0.64 cm; p < 0.001; I2 = 88%; GRADE: very low), at 24 hours (MD = -0.56 cm; 95% CI = -1.14–0.01 cm; p = 0.05; I2 = 97%; GRADE: very low). Conclusions: Magnesium sulfate delayed TFAR and decreased 24-hour opioid consumption and early postoperative pain intensity. However, imprecision and inconsistency pervaded meta-analyses, causing very low certainty of effect estimates.http://www.sciencedirect.com/science/article/pii/S0104001422001063Analgesia, epiduralMagnesium sulfate, therapeutic usePain, postoperative |
| spellingShingle | Getúlio Rodrigues de Oliveira Filho Adilto Mezzari Junior Giulia Nonticuri Bianchi The effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic review Brazilian Journal of Anesthesiology Analgesia, epidural Magnesium sulfate, therapeutic use Pain, postoperative |
| title | The effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic review |
| title_full | The effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic review |
| title_fullStr | The effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic review |
| title_full_unstemmed | The effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic review |
| title_short | The effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic review |
| title_sort | effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain a systematic review |
| topic | Analgesia, epidural Magnesium sulfate, therapeutic use Pain, postoperative |
| url | http://www.sciencedirect.com/science/article/pii/S0104001422001063 |
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