Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

Effect of magnesium sulfate with ketamine infusions on intraoperative and postoperative analgesia in cancer breast surgeries: a randomized double-blind trial

Efeito do sulfato de magnésio com infusões de cetamina na analgesia intra e pós-operatória em cirurgias de câncer de mama: um estudo duplo-cego randomizado

Mohamed Elsayed Hassan; Essam Mahran

Downloads: 5
Views: 977


Opioids are the cornerstone in managing postoperative pain; however, they have many side effects. Ketamine and Magnesium (Mg) are NMDA receptor antagonists used as adjuvant analgesics to decrease postoperative opioid consumption.

We assumed that adding Mg to ketamine infusion can improve the intraoperative and postoperative analgesic efficacy of ketamine infusion alone in cancer breast surgeries.

Ninety patients aged between 18 and 65 years and undergoing elective cancer breast surgery were included in this prospective randomized, double-blind study. Group K received ketamine 0.5 bolus then 0.12 h-1 infusion for the 1st 24 hours postoperatively. Group KM: received ketamine 0.5 and Mg sulfate 50, then ketamine 0.12 h-1 and Mg sulfate 8 h-1 infusions for the 1st 24 hours postoperative. The primary outcome was the morphine consumption in the 1st 24 hours postoperative, while the secondary outcomes were: intraoperative fentanyl consumption, NRS, side effects, and chronic postoperative pain.

Group KM had less postoperative opioid consumption (14.12 ± 5.11 mg) than Group K (19.43 ± 6.8 mg). Also, Group KM had less intraoperative fentanyl consumption. Both groups were similar in postoperative NRS scores, the incidence of side effects related to opioids, and chronic neuropathic pain.

Adding Mg to ketamine infusion can safely improve intraoperative and postoperative analgesia with opioid-sparing effect in cancer breast surgery.


Magnesium sulfate;  Ketamine;  Infusion;  Cancer breast



Os opioides são a pedra angular no controle da dor pós-operatória; no entanto, eles têm muitos efeitos colaterais. A cetamina e o magnésio (Mg) são antagonistas dos receptores NMDA usados como analgésicos adjuvantes para diminuir o consumo de opioides no pós-operatório.


Assumimos que a adição de Mg à infusão de cetamina pode melhorar a eficácia analgésica intra e pós-operatória da infusão de cetamina isoladamente em cirurgias de câncer de mama.


Noventa pacientes com idades entre 18 e 65 anos e submetidas a cirurgia eletiva de câncer de mama foram incluídas neste estudo prospectivo, randomizado e duplo-cego. O grupo K recebeu cetamina 0,5 em bolus e depois 0,12 em infusão nas primeiras 24 horas de pós-operatório. Grupo KM: recebeu cetamina 0,5 e sulfato de Mg 50, depois cetamina 0,12 e sulfato de Mg 8 na primeira infusão 24 horas de pós-operatório. O desfecho primário foi o consumo de morfina nas primeiras 24 horas de pós-operatório, enquanto os desfechos secundários foram: consumo intraoperatório de fentanil, escala numérica da dor, efeitos colaterais e dor crônica pós-operatória.


O grupo KM apresentou menor consumo de opioides no pós-operatório (14,12 ± 5,11 mg) do que o grupo K (19,43 ± 6,8 mg). Além disso, o Grupo KM apresentou menor consumo de fentanil intraoperatório. Ambos os grupos foram semelhantes nos escores pós-operatórios da escala numérica da dor, na incidência de efeitos colaterais relacionados aos opioides e na dor neuropática crônica.


A adição de Mg à infusão de cetamina pode melhorar com segurança a analgesia intra e pós-operatória com efeito poupador de opioides em cirurgia de câncer de mama.


Sulfato de magnésio; Cetamina; Infusão; câncer de mama


1. Poleshuck EL, Katz J, Andrus CH, et al. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain. 2006;7:626-34.

2. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017; 10:2287-98.

3. Viscusi ER. Patient-controlled drug delivery for acute postoperative pain management: a review of current and emerging technologies. Reg Anesth Pain Med. 2008; 33:146-58.

4. Martinez V, Beloeil H, Marret E, et al. Non-opioid analgesics in adults after major surgery: systematic review with network meta-analysis of randomized trials. Br J Anaesth. 2017;118:22-31.

5. Petrenko AB, Yamakura T, Baba H, et al. The role of N-methyl-D-aspartate (NMDA) receptors in pain: a review. Anesth Analg. 2003;97:1108-16.

6. Liu HT, Hollmann MW, Liu WH, et al. Modulation of NMDA receptor function by ketamine and magnesium: Part I. Anesth Analg. 2001;92:1173-81.

7. McCartney CJ, Sinha A, Katz J. A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventive analgesia. Anesth Analg. 2004;98:1385-400.

8. Kim SH, Kim SI, Ok SY, et al. Opioid sparing effect of low dose ketamine in patients with intravenous patient-controlled analgesia using fentanyl after lumbar spinal fusion surgery. Korean J Anesthesiol. 2013;64:524-8.

9. Akhavanakbari G, Mohamadian A, Entezariasl M. Evaluation the effects of adding ketamine to morphine in intravenous patient-controlled analgesia after orthopedic surgery. Perspect Clin Res. 2014;5:85-7.

10. Jendoubi A, Naceur IB, Bouzouita A, et al. A comparison between intravenous lidocaine and ketamine on acute and chronic pain after open nephrectomy: A prospective, double-blind, randomized, placebo-controlled study. Saudi J Anaesth. 2017;11:177-84.

11. Ryu JH, Kang MH, Park KS, et al. Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia. Br J Anaesth. 2008;100:397-403.

12. El Mourad MB, Arafa SK. Effect of intravenous versus intraperitoneal magnesium sulfate on hemodynamic parameters and postoperative analgesia during laparoscopic sleeve gastrectomy-A prospective randomized study. J Anaesthesiol Clin Pharmacol. 2019;35:242-7.

13. Mendonça FT, Pellizzaro D, Grossi BJ, et al. Synergistic effect of the association between lidocaine and magnesium sulfate on perioperative pain after mastectomy: A randomised, double-blind trial. Eur J Anaesthesiol. 2020;37:224-34.

14. Helander EM, Menard BL, Harmon CM, et al. Multimodal Analgesia, Current Concepts, and Acute Pain Considerations. Curr Pain Headache Rep. 2017;21:3.

15. Ramsay MA, Savege TM, Simpson BR, et al. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2:656-9.

16. Bouhassira D, Attal N, Alchaar H, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114:29-36.

17. Jabbour HJ, Naccache NM, Jawish RJ, et al. Ketamine and magnesium association reduces morphine consumption after scoliosis surgery: prospective randomised double-blind study. Acta Anaesthesiol Scand. 2014;58:572-9.

18. Remérand F, Le Tendre C, Baud A, et al. The early and delayed analgesic effects of ketamine after total hip arthroplasty: a prospective, randomized, controlled, double-blind study. Anesth Analg. 2009;109:1963-71.

19. Zakine J, Samarcq D, Lorne E, et al. Postoperative ketamine administration decreases morphine consumption in major abdominal surgery: a prospective, randomized, double-blind, controlled study. Anesth Analg. 2008;106:1856-61.

20. Schmid RL, Sandler AN, Katz J. Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes. Pain. 1999;82:111-25.

21. Tramer MR, Schneider J, Marti RA, et al. Role of magnesium sulfate in postoperative analgesia. Anesthesiology. 1996;84:340-7.

22. O’Flaherty JE, Lin CX. Does ketamine or magnesium affect posttonsillectomy pain in children? Paediatr Anaesth. 2003;13:413-21.

23. Tramèr MR, Glynn CJ. An evaluation of a single dose of magnesium to supplement analgesia after ambulatory surgery: randomized controlled trial. Anesth Analg. 2007;104:1374-9.

24. De Oliveira GS Jr, Castro-Alves LJ, Khan JH, et al. Perioperative systemic magnesium to minimize postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. 2013;119:178-90.

25. Pickering G, Pereira B, Morel V, et al. Ketamine and Magnesium for Refractory Neuropathic Pain: A Randomized, Double-blind, Crossover Trial. Anesthesiology. 2020;133:154-64.

Submitted date:

Accepted date:

6107f3fca953953fc77e6072 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections