Abstract
We aimed to investigate whether perioperative magnesium sulfate administration was associated with the incidence of chronic persistent postoperative pain (PPP) following total knee arthroplasty (TKA). This retrospective observational study was performed at a single tertiary academic hospital. We reviewed the medical records of adult patients who were admitted between August 2012 and July 2017. Patients who received magnesium sulfate during surgery were the magnesium group. The presence of PPP, one year after TKA, was evaluated using a binary logistic regression analysis. A total of 924 patients were included in the analysis, and 148 patients (16.0%) experienced PPP one year after TKA. In the multivariable model, the magnesium group had a 62% lower rate of PPP one year after TKA compared to the control group (odds ratio (OR): 0.38, 95% confidence interval (CI): 0.16 to 0.90; p = 0.027). This finding was similar in the sensitivity analysis using propensity score adjustment (OR: 0.38, 95% CI: 0.16 to 0.93; p = 0.036). We showed that perioperative magnesium sulfate administration was associated with a lower rate of PPP one year after TKA. Our results suggest that magnesium sulfate administered perioperatively is effective for the alleviation of acute and chronic pain after surgery.
Highlights
Total knee arthroplasty (TKA) is one of the most commonly performed surgical procedures in developed countries [1]
The mechanism of the analgesic effect of magnesium sulfate is thought to be its antagonistic effect on N-methyl-D-aspartate (NMDA) receptors [11], which are associated with the development of central sensitization after peripheral tissue injury or inflammation [12,13]
48 patients were excluded for the following reasons: preoperative American Society of Anesthesiologists (ASA) physical status ≥ 3 (n = 4), secondary OA (n = 3), history of previous surgery on the knee (n = 30), failed femoral nerve block (n = 10), and epidural patient controlled analgesia (PCA) administered (n = 1)
Summary
Total knee arthroplasty (TKA) is one of the most commonly performed surgical procedures in developed countries [1]. In addition to alleviating acute postoperative pain, magnesium sulfate may be effective at preventing chronic PPP after TKA. This effect is explained by two theories. The mechanism of the analgesic effect of magnesium sulfate is thought to be its antagonistic effect on N-methyl-D-aspartate (NMDA) receptors [11], which are associated with the development of central sensitization after peripheral tissue injury or inflammation [12,13]. Central sensitization is known to be an important mechanism of chronic PPP development, as described in a previous study [14]. The antagonizing effect of magnesium sulfate on calcium channels attenuates both the development of central sensitization and chronic PPP after TKA.
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