Abstract
The purpose of this study was to summarize and evaluate evidence on the effectiveness of perioperative magnesium as an adjuvant for postoperative analgesia. We conducted an umbrella review of the evidence across systematic reviews and meta-analyses of randomized controlled trials (RCTs) on the effect of perioperative magnesium on pain after surgical procedures. Two independent investigators retrieved pain-related outcomes and assessed the methodological quality of the evidence of included studies using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) tool, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. In addition, an updated meta-analysis of postoperative pain-related outcomes with a trial sequential analysis (TSA) was conducted. Of the 773 articles initially identified, 17 systematic reviews and meta-analyses of 258 RCTs were included in the current umbrella review. Based on the AMSTAR tool, the overall confidence of the included systematic reviews was deemed critically low to low. Pain score, analgesic consumption, time to first analgesic request, and incidence of analgesic request were examined as pain-related outcomes. According to the GRADE system, the overall quality of evidence ranged from very low to moderate. While the updated meta-analysis showed the beneficial effect of perioperative magnesium on postoperative analgesia, and TSA appeared to suggest sufficient existing evidence, the heterogeneity was substantial for every outcome. Although the majority of included systematic reviews and updated meta-analysis showed a significant improvement in outcomes related to pain after surgery when magnesium was administered during the perioperative period, the evidence reveals a limited confidence in the beneficial effect of perioperative magnesium on postoperative pain.
Highlights
Postoperative pain can be linked to various pathophysiological pathways, including neuropathic and inflammatory pathways [1]
The time to first analgesic was significantly longer in the magnesium group than in the control group (SMD = −1.867; 95% confidence intervals (CIs), −2.216 to −1.519; pchi 2 < 0.001; I2 = 94.8%)
Analgesic consumption was significantly reduced with the use of magnesium compared to the control group (SMD = 1.456; 95% CI, 1.163–1.749; pchi 2 < 0.001; I2 = 94.7%)
Summary
Postoperative pain can be linked to various pathophysiological pathways, including neuropathic and inflammatory pathways [1]. These various factors can be considered when developing a pain-management strategy following surgery. In this regard, there is a growing interest in the use of multimodal analgesia as an important component of ideal methods for postoperative pain management [2]. Magnesium has been shown to have analgesic benefits when used as an adjuvant in surgical patients and can contribute to being part of a balanced analgesia strategy [3,4]. The regulation of calcium influx into the cell and antagonism of N-methyl-Daspartate (NMDA) receptors in the central nervous system are assumed to be responsible for magnesium’s analgesic activity; the exact mechanism remains uncertain [5,6].
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