Unravelling the analgesic effects of perioperative magnesium in general abdominal surgery: a systematic review and meta-analysis of randomized controlled trials
Desvendando os efeitos analgésicos do magnésio perioperatório em cirurgia abdominal geral: uma revisão sistemática e meta-análise de ensaios clínicos randomizados
Yasin Avci, Manikandan Rajarathinam, Neha Kalsekar, Qutaiba Tawfic, Sarah Krause, Derek Nguyen, Eric Liu, Mahesh Nagappa, Yamini Subraman
Abstract
Background
Prior research has established the effectiveness of magnesium in relieving postoperative pain. This article aims to evaluate magnesium sulfate for perioperative analgesia in adults undergoing general abdominal surgery under general anesthesia.
Objective
The primary aim was to assess pain scores at 6 and 24 hours postoperatively in patients receiving magnesium sulfate vs. the control group. Secondary outcomes were postoperative opioid consumption, perioperative complications, and time to rescue analgesia.
Methods
A comprehensive database search identified studies comparing magnesium sulfate with control in adults undergoing general anesthesia for general abdominal surgery. Using random-effects models, data were presented as mean ± Standard Deviation (SD) or Odds Ratios (OR) with corresponding 95% Confidence Intervals (95% CI). A two-sided p-value < 0.05 was considered statistically significant.
Results
In total, 31 studies involving 1762 participants met the inclusion criteria. The magnesium group showed significantly lower postoperative pain scores at both early (within six hours) and late (up to 24 hours) time points compared to the control group. The early mean score was 3.1 ± 1.4 vs. 4.2 ± 2.3, and the late mean score was 2.3 ± 1.1 vs. 2.7 ± 1.5, resulting in an overall Mean Difference (MD) of −0.72; 95% CI −0.99, −0.44; p < 0.00001. The magnesium group was associated with lower rates of postoperative opioid consumption and shivering and had a longer time to first analgesia administration compared to the saline control group.
Conclusion
Magnesium sulfate administration was linked to reduced postoperative pain and opioid consumption following general abdominal surgery.
Keywords
Resumo
Introdução
Pesquisas anteriores estabeleceram a eficácia do magnésio no alívio da dor pós-operatória. Este artigo tem como objetivo avaliar o sulfato de magnésio para analgesia perioperatória em adultos submetidos à cirurgia abdominal geral sob anestesia geral.
O objetivo principal foi avaliar os escores de dor 6 e 24 horas de pós-operatório em pacientes que receberam sulfato de magnésio versus o grupo controle. Os desfechos secundários foram consumo de opioides no pós-operatório, complicações perioperatórias e tempo para resgatar analgesia.
Métodos
Uma pesquisa abrangente em bancos de dados identificou estudos comparando sulfato de magnésio com controle em adultos submetidos à anestesia geral para cirurgia abdominal geral. Utilizando modelos de efeitos aleatórios, os dados foram apresentados como média ± desvio padrão (DP) ou odds ratio (OR) com correspondentes intervalos de confiança de 95% (IC 95%). Um valor de p bilateral < 0,05 foi considerado estatisticamente significativo.
Resultados
No total, 31 estudos envolvendo 1.762 participantes preencheram os critérios de inclusão. O grupo do magnésio apresentou escores de dor pós-operatória significativamente mais baixos tanto no início (dentro de seis horas) quanto no final (até 24 horas) em comparação ao grupo controle. A pontuação média inicial foi de 3,1 ± 1,4 vs. 4,2 ± 2,3, e a pontuação média tardia foi de 2,3 ± 1,1 vs. 2,7 ± 1,5, resultando em uma diferença média geral (DM) de -0,72; IC 95% −0,99, −0,44; p < 0,00001. O grupo do magnésio foi associado a menores taxas de consumo de opióides no pós-operatório e tremores e teve um tempo maior para a primeira administração de analgesia em comparação com o grupo controle de solução salina.
Conclusão
A administração de sulfato de magnésio foi associada à redução da dor pós-operatória e ao consumo de opioides após cirurgia abdominal geral.
Palavras-chave
Referências
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Submetido em:
18/01/2024
Aceito em:
24/05/2024
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