Intrathecal magnesium as analgesic adjuvant for spinal anesthesia

A meta-analysis of randomized trials

Francisco Pascual-Ramirez, S. Gil-Trujillo, C. Alcantarilla

Research output: Contribution to journalReview article

19 Citations (Scopus)

Abstract

Background. The efficacy and safety of intrathecal magnesium as analgesic adjuvant has been tested by several clinical trials in recent years. We performed a meta-analysis of the available literature. Methods. Randomized clinical trials comparing a 50 to 100 mg dose of intrathecal magnesium sulfate versus placebo in addition to an intrathecal local anesthetic and/or opiate for a below-umbilicus procedure were included. Medline, LILACS, Cochrane Library and Google Scholar databases were searched. A random analysis was performed and heterogeneity was tested for. The size of the effect for quantitative outcomes was calculated as standard mean difference (SMD, neutral=0); and as odds ratio (OR, neutral= 1) for dichotomous outcomes. Results. Twelve studies totaling 817 patients were included. The "time to first analgesia request" was at least 35 minutes longer when intrathecal magnesium was included in the intervention (SDM 0.94, 95%CI 0.51 to 1.37, P<0.001). The "onset time to sensory block" (SDM 0.64, 95%CI 0.15 to 1.12, P=0.01) and the "time to maximal motor block" (SDM 0.97, 95%CI 0.28 to 1.67, P=0.006) were 2.4 minutes slower with intrathecal magnesium. There was no difference in "time to full motor recovery, incidence of pruritus, postoperative nausea and vomiting, bradicardia, low blood pressure and urinary retention". No cases of respiratory depression or neurotoxicity were recorded in these studies. Conclusion. The inclusion of 50 to 100 mg of intrathecal magnesium in a spinal anesthetic prolongs opiate analgesia duration; no safety concerns have been identified by the included clinical studies but additional evidence is advised.

Original languageEnglish (US)
Pages (from-to)667-678
Number of pages12
JournalMinerva Anestesiologica
Volume79
Issue number6
StatePublished - Jun 1 2013
Externally publishedYes

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Spinal Anesthesia
Magnesium
Analgesics
Meta-Analysis
Opiate Alkaloids
Analgesia
Safety
Umbilicus
Postoperative Nausea and Vomiting
Magnesium Sulfate
Urinary Retention
Pruritus
Local Anesthetics
Respiratory Insufficiency
Hypotension
Libraries
Anesthetics
Randomized Controlled Trials
Odds Ratio
Placebos

Keywords

  • Analgesia
  • Magnesium
  • Meta-analysis as topic

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Intrathecal magnesium as analgesic adjuvant for spinal anesthesia : A meta-analysis of randomized trials. / Pascual-Ramirez, Francisco; Gil-Trujillo, S.; Alcantarilla, C.

In: Minerva Anestesiologica, Vol. 79, No. 6, 01.06.2013, p. 667-678.

Research output: Contribution to journalReview article

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abstract = "Background. The efficacy and safety of intrathecal magnesium as analgesic adjuvant has been tested by several clinical trials in recent years. We performed a meta-analysis of the available literature. Methods. Randomized clinical trials comparing a 50 to 100 mg dose of intrathecal magnesium sulfate versus placebo in addition to an intrathecal local anesthetic and/or opiate for a below-umbilicus procedure were included. Medline, LILACS, Cochrane Library and Google Scholar databases were searched. A random analysis was performed and heterogeneity was tested for. The size of the effect for quantitative outcomes was calculated as standard mean difference (SMD, neutral=0); and as odds ratio (OR, neutral= 1) for dichotomous outcomes. Results. Twelve studies totaling 817 patients were included. The {"}time to first analgesia request{"} was at least 35 minutes longer when intrathecal magnesium was included in the intervention (SDM 0.94, 95{\%}CI 0.51 to 1.37, P<0.001). The {"}onset time to sensory block{"} (SDM 0.64, 95{\%}CI 0.15 to 1.12, P=0.01) and the {"}time to maximal motor block{"} (SDM 0.97, 95{\%}CI 0.28 to 1.67, P=0.006) were 2.4 minutes slower with intrathecal magnesium. There was no difference in {"}time to full motor recovery, incidence of pruritus, postoperative nausea and vomiting, bradicardia, low blood pressure and urinary retention{"}. No cases of respiratory depression or neurotoxicity were recorded in these studies. Conclusion. The inclusion of 50 to 100 mg of intrathecal magnesium in a spinal anesthetic prolongs opiate analgesia duration; no safety concerns have been identified by the included clinical studies but additional evidence is advised.",
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AU - Pascual-Ramirez, Francisco

AU - Gil-Trujillo, S.

AU - Alcantarilla, C.

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N2 - Background. The efficacy and safety of intrathecal magnesium as analgesic adjuvant has been tested by several clinical trials in recent years. We performed a meta-analysis of the available literature. Methods. Randomized clinical trials comparing a 50 to 100 mg dose of intrathecal magnesium sulfate versus placebo in addition to an intrathecal local anesthetic and/or opiate for a below-umbilicus procedure were included. Medline, LILACS, Cochrane Library and Google Scholar databases were searched. A random analysis was performed and heterogeneity was tested for. The size of the effect for quantitative outcomes was calculated as standard mean difference (SMD, neutral=0); and as odds ratio (OR, neutral= 1) for dichotomous outcomes. Results. Twelve studies totaling 817 patients were included. The "time to first analgesia request" was at least 35 minutes longer when intrathecal magnesium was included in the intervention (SDM 0.94, 95%CI 0.51 to 1.37, P<0.001). The "onset time to sensory block" (SDM 0.64, 95%CI 0.15 to 1.12, P=0.01) and the "time to maximal motor block" (SDM 0.97, 95%CI 0.28 to 1.67, P=0.006) were 2.4 minutes slower with intrathecal magnesium. There was no difference in "time to full motor recovery, incidence of pruritus, postoperative nausea and vomiting, bradicardia, low blood pressure and urinary retention". No cases of respiratory depression or neurotoxicity were recorded in these studies. Conclusion. The inclusion of 50 to 100 mg of intrathecal magnesium in a spinal anesthetic prolongs opiate analgesia duration; no safety concerns have been identified by the included clinical studies but additional evidence is advised.

AB - Background. The efficacy and safety of intrathecal magnesium as analgesic adjuvant has been tested by several clinical trials in recent years. We performed a meta-analysis of the available literature. Methods. Randomized clinical trials comparing a 50 to 100 mg dose of intrathecal magnesium sulfate versus placebo in addition to an intrathecal local anesthetic and/or opiate for a below-umbilicus procedure were included. Medline, LILACS, Cochrane Library and Google Scholar databases were searched. A random analysis was performed and heterogeneity was tested for. The size of the effect for quantitative outcomes was calculated as standard mean difference (SMD, neutral=0); and as odds ratio (OR, neutral= 1) for dichotomous outcomes. Results. Twelve studies totaling 817 patients were included. The "time to first analgesia request" was at least 35 minutes longer when intrathecal magnesium was included in the intervention (SDM 0.94, 95%CI 0.51 to 1.37, P<0.001). The "onset time to sensory block" (SDM 0.64, 95%CI 0.15 to 1.12, P=0.01) and the "time to maximal motor block" (SDM 0.97, 95%CI 0.28 to 1.67, P=0.006) were 2.4 minutes slower with intrathecal magnesium. There was no difference in "time to full motor recovery, incidence of pruritus, postoperative nausea and vomiting, bradicardia, low blood pressure and urinary retention". No cases of respiratory depression or neurotoxicity were recorded in these studies. Conclusion. The inclusion of 50 to 100 mg of intrathecal magnesium in a spinal anesthetic prolongs opiate analgesia duration; no safety concerns have been identified by the included clinical studies but additional evidence is advised.

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KW - Meta-analysis as topic

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