Intravenous magnesium sulfate for postoperative analgesia after abdominal hysterectomy under spinal anesthesia: a randomized, double-blind trial

Márcio Luiz Benevides, Danielle Carvalho Fialho, Daiane Linck, Ana Luiza Oliveira, Dennis Henrique Vieira Ramalho, Marília Marquioreto Benevides, Márcio Luiz Benevides, Danielle Carvalho Fialho, Daiane Linck, Ana Luiza Oliveira, Dennis Henrique Vieira Ramalho, Marília Marquioreto Benevides

Abstract

Background and objectives: Abdominal Hysterectomy (AH) is associated with significant inflammatory response and can result in moderate to severe postoperative pain. This study aimed to evaluate the efficacy of magnesium infusion in reducing postoperative pain and analgesic consumption after AH under spinal anesthesia with Intrathecal Morphine (ITM).

Method: Eighty-six patients were included in this clinical, controlled, randomized, double-blind study. Patients received in Group Mg, MgSO4 50mgkg-1 for 15 minutes followed by 15 mgkg-1h-1 until the end of the surgery; and in Group C, (control) the same volume of isotonic saline. Both groups received 100μg of ITM. All patients received dipyrone+ketoprofen intraoperatively and postoperatively, and dexamethasone intraoperatively only. We evaluated the intensity of pain, tramadol consumption, and adverse events 24hours postoperatively.

Results: Serum magnesium concentrations were higher in Group Mg at the end, and one hour after the operation (p=0.000). Postoperative pain scores were reduced in Group Mg at 6 hours at rest and on movement (p<0.05). Tramadol consumption did not show a statistically significant difference between Group Mg and Group C (15.5±36.6mg and 29.2±67.8mg respectively, p=0.53). Hemodynamic variables, the incidence of pruritus, nausea, and vomiting were similar in the two groups.

Conclusion: Infusion of MgSO4 during AH undergoing spinal anesthesia with ITM reduced at 6 hours at rest and on movement. More studies should be performed to evaluate the potential antinociceptive effect of MgSO4 in scenarios where a multimodal analgesia approach was employed.

Keywords: Hysterectomy; Magnesium sulfate; Morphine; Postoperative pain; Spinal anesthesia; Tramadol.

Copyright © 2021. Published by Elsevier Editora Ltda.

Figures

Figure 1
Figure 1
The flow chart of the study.
Figure 2
Figure 2
Mean arterial pressure (mean and 95% confidence interval) according to group and time. Horizontal axis: 0 (baseline), 15, 30, 60, 90, 120 minutes, and at Postanesthesia Care Unit (PACU). Variable group (p = 0.59); variable time (p = 0.000); variable time versus group (p = 0.73). Generalized estimating equations model.
Figure 3
Figure 3
Heart rate (mean and 95% Confidence Interval) according to group and time. Horizontal axis: 0 (baseline), 15, 30, 60, 90, 120 minutes, and at Postanesthesia Care Unit (PACU). Variable group (p = 0.054); variable time (p = 0.000); variable time versus group (p = 0.12). Generalized estimating equations model.

References

    1. Aarts J.W., Nieboer T.E., Johnson N., et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015;2015:CD003677.
    1. Brandsborg B. Pain following hysterectomy: epidemiological and clinical aspects. Dan Med J. 2012;59:B4374.
    1. Kim T.K., Yoon J.R. Comparison of the neuroendocrine and inflammatory responses after laparoscopic and abdominal hysterectomy. Korean J Anesthesiol. 2010;59:265–269.
    1. Beverly A., Kaye A.D., Ljungqvist O., Urman R.D. Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines. Anesthesiol Clin. 2017;35:e115–e143.
    1. Azari L., Santoso J.T., Osborne S.E. Optimal pain management in total abdominal hysterectomy. Obstet Gynecol Surv. 2013;68:215–227.
    1. Wodlin N.B., Nilsson L., Arestedt . Mode of anesthesia and postoperative symptoms following abdominal hysterectomy in a fast-track setting. Acta Obstet Gynecol Scand. 2011;90:369–379.
    1. Hein A., Rösblad P., Gillis-Haegerstrand, et al. Low dose intrathecal morphine effects on post-hysterectomy pain: a randomized placebo-controlled study. Anaesthesiol Scand. 2012;56:102–109. doi: 10.1111/j.1399-6576.2011.02574.x.
    1. Borendal Wodlin N., Nilsson L., Carlsson P., Kjølhede P. Cost-effectiveness of general anesthesia vs spinal anesthesia in fast-track abdominal benign hysterectomy. Am J Obstet Gynecol. 2011;205 326.e1326.e3267.
    1. Baldini G., Carli F. Anesthetic and adjunctive drugs for fast-track surgery. Curr Drug Targets. 2009;10:667–686.
    1. Brown E.N., Pavone K.J., Naranjo M. Multimodal General Anesthesia: Theory and Practice. Anesth Analg. 2018;127:12461258.
    1. Sang-Hwan Do. Magnesium: a versatile drug for anesthesiologists Korean J Anesthesiol. 2013;65:4–8.
    1. Ramsay M.A., Savege T.M., Simpson B.R., Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2:656–659.
    1. Aldrete J.A. The Post-Anesthetic Recovery Score Revisited. J Clin Anesth. 1995;7:89–91.
    1. Catro-Alves L.J., De Azevedo V.L., De Freitas Braga T.F., Goncalves A.C., De Oliveira G.S., Jr. The effect of neuraxial versus general anesthesia techniques on postoperative quality of recovery and analgesia after abdominal hysterectomy: a prospective, randomized, controlled trial. Anesth Analg. 2011;113:1480–1486.
    1. Khorasanizadeh S., Panahi M., Mohseni G., et al. Comparison of analgesia in subcutaneous infiltration of ropivacaine and magnesium sulfate for postoperative pain control of cholecystectomy. Novel Biomed. 2020;8:13–19.
    1. Bujalska-Zadrożny M., Tatarkiewicz J., Kulik K., Filip M., Naruszewicz M. Magnesium enhances opioid-induced analgesia – What we have learnt in the past decades? Eur J Pharm Sci. 2017;99:113–127.
    1. Hwang J.Y., Na H.S., Jeon Y.T., et al. Infusion of magnesium sulphate during spinal anaesthesia improves postoperative analgesia. Br J Anaesth. 2009;103:861–866.
    1. Agrawal A., Agrawal S., payal Y.S. Effect of continuous magnesium sulfate infusion on spinal block characteristics: A prospective study. Saudi J Anaesth. 2014;8:78–82.
    1. Ryu J.H., Kang M.H., Park K.S., Do S.H. Effects of magnesium sulphate on intraoperative anesthetic requirements and postoperative analgesia in gynecology patients receiving total intravenous anesthesia. Br J Anaesth. 2008;100:397–403.
    1. Seyhan T.O., Tugrul M., Sungur M.O., et al. Effects of three different dose regimens of magnesium on propofol requirements, haemodynamic variables and postoperative pain relief in gynaecological surgery. Br J Anaesth. 2006;96:247–252.
    1. Albrecht E., Kirkham K.R., Liu S.S., Brull R. Peri-operative intravenous administration of magnesium sulphate and postoperative pain: a meta-analysis. Anaesthesia. 2013;68:79–90.
    1. Taheri A., Haryalchi K., Mansour Ghanaie M., Habibi Arejan N. Effect of low-dose (single-dose) magnesium sulfate on postoperative analgesia in hysterectomy patients receiving balanced general anesthesia. Anesthesiol Res Pract. 2015;2015:306145.
    1. Asadollah S., Vahdat M., Yazdkhasti P., et al. Magnesium sulphate on postoperative analgesia requirements. 2015 J Turk Soc Obstet Gynecol. 2015;1:34–37.
    1. Haryalchi K., Abedinzade M., Khanaki K., et al. Whether preventive low dose magnesium sulphate infusion has an influence on postoperative pain perception and the level of serum beta-endorphin throughout the total abdominal hysterectomy. Rev Esp Anestesiol Reanim. 2017;64:384–390.
    1. Ghaffaripour S., Mahmoudi H., Eghbal H., et al. The effect of intravenous magnesium sulfate on post-operative analgesia during laminectomy. Cureus. 2016;8:e626.
    1. Ghezel-Ahmadi V., Ghezel-Ahmadi D., Schirren J., et al. Perioperative systemic magnesium sulphate to minimize acute and chronic post-thoracotomy pain: a prospective observational study. J Thorac Dis. 2019;11:418–426.
    1. Chen C., Tao R. The impact of magnesium sulfate on pain control after 28. laparoscopic cholecystectomy: a meta-analysis of randomized controlled studies. Surg Laparosc Endosc Percutan Tech. 2018;28:349–353.
    1. Kahraman F., Eroglu A. The effect of intravenous magnesium sulfate infusion on sensory spinal block and postoperative pain score in abdominal hysterectomy. BioMed Research International. 2014;2014:236024.
    1. Shah P.N., Dhengle Y. Magnesium sulfate for postoperative analgesia after surgery under spinal anesthesia. Acta Anaesthesiol Taiwan. 2016;54:62–64.
    1. Zhong H.Y., Zhang W.P. Effect of intravenous magnesium sulfate on bupivacaine spinal anesthesia in preeclamptic patients. Biomed Pharmacother. 2018;108:1289–1293.
    1. Shin H.J., Kim E.Y., Na H.S., Kim T.K., Kim M.H., Do S.H. Magnesium sulphate attenuates acute postoperative pain and increased pain intensity after surgical injury in staged bilateral total knee arthroplasty: a randomized, double-blinded, placebo-controlled trial. Br J Anaesth. 2016;117:497–503.
    1. Frassanito L., Messina A., Vergari A., et al. Intravenous infusion of magnesium sulfate and postoperative analgesia in total knee arthroplasty. Minerva Anestesiol. 2015;81:1184–1191.
    1. Peng Y.N., Sung F.C., Huang M.L., et al. The use of intravenous magnesium sulfate on postoperative analgesia in orthopedic surgery A systematic review of randomized controlled trial. Medicine (Baltimore). 2018;97:e13583.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever