Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.01.008
Brazilian Journal of Anesthesiology
Clinical Research

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

Sulfato de magnésio intravenoso para analgesia pós-operatória após histerectomia abdominal sob anestesia espinhal: um estudo duplo-cego randomizado

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

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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 50 mg kg−1 for 15-minutes followed by 15-mg kg−1 h−1 until the end of the surgery; and in Group C, (control) the same volume of isotonic saline. Both groups received 100 μg 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 24 h 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 ± 36.6 mg and 29.2 ± 67.8 mg 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;  Tramadol;  Postoperative pain;  Spinal anesthesia;  Morphine

Resumo

Justificativa e objetivos: A histerectomia abdominal (HA) está associada a uma resposta inflamatória significativa e pode resultar em dor pós-operatória moderada a intensa. Este estudo teve como objetivo avaliar a eficácia da infusão de magnésio na redução da dor pós-operatória e do consumo de analgésicos após HA sob raquianestesia com Morfina Intratecal (MIT). Método: Oitenta e seis pacientes foram incluídas neste estudo clínico, controlado, randomizado e duplo-cego. As pacientes receberam no Grupo MgSO4 50 mg kg −1 por 15 minutos seguido de 15 mg kg −1 h −1 até o final da cirurgia; e no Grupo C, (controle) o mesmo volume de solução salina isotônica. Ambos os grupos receberam 100 g de MIT. Todas as pacientes receberam dipirona + cetoprofeno no intra e pós-operatório e dexametasona apenas no intraoperatório. Avaliamos a intensidade da dor, o consumo de tramadol e os eventos adversos 24 horas no pós-operatório. Resultados: As concentrações de magnésio sérico foram maiores no Grupo Mg no final e uma hora após a operação (p = 0,000). Os escores de dor pós-operatória foram reduzidos no Grupo Mg em 6 horas em repouso e em movimento (p <0,05). O consumo de tramadol não apresentou diferença estatisticamente significativa entre o Grupo Mg e o Grupo C (15,5 ± 36,6 mg e 29,2 ± 67,8 mg, respectivamente, p = 0,53). As variáveis hemodinâmicas, a incidência de prurido, náuseas e vômitos foram semelhantes nos dois grupos. Conclusão: A infusão de MgSO4 durante HA submetidos à raquianestesia com MIT reduziu após 6 horas em repouso e em movimento. Mais estudos devem ser realizados para avaliar o potencial efeito antinociceptivo do MgSO4 em cenários onde uma abordagem de analgesia multimodal foi empregada.

Palavras-chave

Histerectomia; Sulfato de magnésio; Tramadol; Dor pós-operatória; Raquianestesia; Morfina

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