Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2020

Open Access 01-12-2020 | Analgesics in Dentistry | Research article

Comparative evaluation of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia: a meta-analysis of randomized controlled trials

Authors: Li-Qin Li, Mei-Dan Fang, Cong Wang, Hong-Liu Lu, Li-Xue Wang, Hong-Yu Xu, Hou-Zhong Zhang

Published in: BMC Anesthesiology | Issue 1/2020

Login to get access

Abstract

Background

The comparative efficacy of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia remains controversial.

Methods

We searched Mediline (OvidSP), EMBASE (OvidSP) and Cochrane Central Register of Controlled Trials (CENTRAL) to identify trials that compared epidural bupivacaine and magnesium sulfate combination (intervention) with bupivacaine alone (control). Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework was used to assess the quality of evidence.

Results

Eleven studies fulfilled our inclusion criteria after screening. We found that epidural bupivacaine combined with magnesium sulfate could prolong the time for first rescue analgesics (SMD 4.96; 95% CI [2.75, 7.17], P < 0.00001, I2 = 98%), reduce the number of patients who need rescue analgesics (RR 0.38; 95% CI [0.20, 0.74], P = 0.004, I2 = 75%) and requirement for rescue analgesics (SMD -2.65; 95% CI [− 4.23, − 1.06], P = 0.001, I2 = 96%).

Conclusions

Magnesium suifate as an adjuvant of epidural bupivacaine improved postoperative analgesia. However, we rated the quality of evidence to be very low because of high heterogeneity, imprecise of results and small sample sizes. Furthermore, further large high-quality trials are still needed to confirm the effects of magnesium sulfate on postoperative analgesia.
Appendix
Available only for authorised users
Literature
1.
Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287–98.CrossRef
2.
Joshi GP, Ogunnaike BO. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North Am. 2005;23(1):21–36.CrossRef
3.
Ng A, Swanevelder J. Pain relief after thoracotomy: is epidural analgesia the optimal technique? Br J Anaesth. 2007;98(2):159–62.CrossRef
4.
Tan X, Shen L, Wang L, et al. Incidence and risk factors for epidural morphine induced pruritus in parturients receiving cesarean section: a prospective multicenter observational study. Medicine (Baltimore). 2019;98(40):e17366.CrossRef
5.
Turkoglu Z, Karacaer F, Biricik E, et al. Comparison of the effects of epidural Levobupivacaine with tramadol or morphine addition on postoperative analgesia following major abdominal surgery. Turk J Anaesthesiol Reanim. 2019;47(4):287–94.CrossRef
6.
Sekhar DP, Kumar L, Kesavan R, et al. Comparison of the analgesic efficacy of a single dose of epidural Dexmedetomidine versus fentanyl as an adjuvant to bupivacaine in abdominal surgery. Anesth Essays Res. 2019;13(3):465–70.CrossRef
7.
Begon S, Pickering G, Eschalier A, et al. Magnesium increases morphine analgesic effect in different experimental models of pain. Anesthesiol. 2002;96(3):627–32.CrossRef
8.
Kogler J . The analgesic effect of magnesium sulfate in patients undergoing thoracotomy. Acta Clin Croat 2009; 48(1):19–26.
9.
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.CrossRef
10.
Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6.CrossRef
11.
12.
Elsharkawy RA, Farahat TE, Abdelhafez MS. Analgesic effect of adding magnesium sulfate to epidural levobupivacaine in patients with pre-eclampsia undergoing elective cesarean section. J Anaesthesiol Clin Pharmacol. 2018;34(3):328–34.PubMedPubMedCentral
13.
Ghatak T, Chandra G, Malik A, et al. Evaluation of the effect of magnesium sulphate vs. clonidine as adjunct to epidural bupivacaine. Indian J Anaesth. 2010;54(4):308–13.CrossRef
14.
Mohammad W, Mir SA, Mohammad K, et al. A randomized double-blind study to evaluate efficacy and safety of epidural magnesium sulfate and clonidine as adjuvants to bupivacaine for postthoracotomy pain relief. Anesth Essays Res. 2015;9(1):15–20.PubMedPubMedCentral
15.
Shahi V, Verma AK, Agarwal A, et al. A comparative study of magnesium sulfate vs dexmedetomidine as an adjunct to epidural bupivacaine. J Anaesthesiol Clin Pharmacol. 2014;30(4):538–42.CrossRef
16.
Sun J, Wu X, Xu X, et al. A comparison of epidural magnesium and/or morphine with bupivacaine for postoperative analgesia after cesarean section. Int J Obstet Anesth. 2012;21(4):310–6.CrossRef
17.
Gupta A, Goyal VK, Gupta N, et al. A randomized controlled trial to evaluate the effect of addition of a single dose of epidural magnesium sulphate on the duration of postoperative analgesia in patients undergoing lower abdominal surgeries under epidural anaesthesia. Sri Lankan J Anaesthesiol. 2013;21(1):27–31.CrossRef
18.
Shruthi AH, Sudheesh K, Nethra SS, et al. The effect of a single dose of magnesium Sulphate as an adjuvant to epidural bupivacaine for Infraumbilical surgeries: a prospective double-blind, randomized control trial. Middle East J Anesthesiol. 2016;23(4):449–55.PubMed
19.
Aly Kandil AH, Hammad RAEA, Shafei MAE, et al. Preemptive use of epidural magnesium sulphate to reduce narcotic requirements in orthopedic surgery. Egypt J Anaesth. 2011;28(1):17–22.CrossRef
20.
Omar H. Magnesium sulfate as a preemptive adjuvant to Levobupivacaine for postoperative analgesia in lower abdominal and pelvic surgeries under epidural anesthesia (randomized controlled trial). Anesth Essays Res. 2018;12(1):256–61.CrossRef
21.
Radwan T, Awad M, Fahmy R, et al. Evaluation of analgesia by epidural magnesium sulphate versus fentanyl as adjuvant to levobupivacaine in geriatric spine surgeries. Randomized controlled study. Egypt J Anaesth. 2017;33(4):357–63.CrossRef
22.
Daabiss MA, Kandil A. Evaluation of the effect of magnesium vs. midazolam as adjunct to epidural bupivacaine in patients undergoing total knee replacement. Br J Med Pract. 2013;6(2):a610.
23.
Mayer ML, Westbrook GL, Guthrie PB. Voltage-dependent block by Mg2+ of NMDA responses in spinal cord neurones. Nat. 1984;309(5965):261–3.CrossRef
24.
Peng YN, Sung FC, Huang ML, et al. The use of intravenous magnesium sulfate on postoperative analgesia in orthopedic surgery: a systematic review of randomized controlled trials. Med (Baltimore). 2018;97(50):e13583.CrossRef
25.
Guo BL, Lin Y, Hu W, et al. Effects of systemic magnesium on post-operative analgesia: is the current evidence strong enough? Pain Physician. 2015;18(5):405–18.PubMed
26.
Xie M, Li XK, Peng Y. Magnesium sulfate for postoperative complications in children undergoing tonsillectomies: a systematic review and meta-analysis. J Evid Based Med. 2017;10(1):16–25.CrossRef
27.
Ko SH, Lim HR, Kim DC, et al. Magnesium sulfate does not reduce postoperative analgesic requirements. Anesthesiol. 2001;95(3):640–6.CrossRef
28.
Wang SC, Pan PT, Chiu HY, et al. Neuraxial magnesium sulfate improves postoperative analgesia in cesarean section delivery women: a meta-analysis of randomized controlled trials. Asian J Anesthesiol. 2017;55(3):56–67.CrossRef
29.
Kawakami H, Mihara T, Nakamura N, et al. Effect of magnesium added to local anesthetics for caudal anesthesia on postoperative pain in pediatric surgical patients: a systematic review and meta-analysis with trial sequential analysis. PLoS One. 2018;13(1):e0190354.CrossRef
30.
Ghoneim MM, Long JP. The interaction between magnesium and other neuromuscular blocking agents. Anesthesiol. 1970;32(1):23–7.CrossRef
31.
Kim MH, Oh AY, Jeon YT, et al. A randomised controlled trial comparing rocuronium priming, magnesium pre-treatment and a combination of the two methods. Anaesth. 2012;67(7):748–54.CrossRef
32.
Lysakowski C, Dumont L, Czarnetzki C, et al. Magnesium as an adjuvant to postoperative analgesia: a systematic review of randomized trials. Anesth Analg. 2007;104(6):1532–9.CrossRef
Metadata
Title
Comparative evaluation of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia: a meta-analysis of randomized controlled trials
Authors
Li-Qin Li
Mei-Dan Fang
Cong Wang
Hong-Liu Lu
Li-Xue Wang
Hong-Yu Xu
Hou-Zhong Zhang
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2020
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-020-0947-8

Other articles of this Issue 1/2020

BMC Anesthesiology 1/2020 Go to the issue

Research article

Laryngeal mask versus facemask in the respiratory management during catheter ablation

Research article

PreAnaesThesia computerized health (PATCH) assessment: development and validation

Case report

Direct acute respiratory distress syndrome after gastric perforation caused by an intragastric balloon: a case report

Research article

Intravenous lidocaine to prevent endothelial dysfunction after major abdominal surgery: a randomized controlled pilot trial

Research article

Acute kidney injury risk prediction score for critically-ill surgical patients

Research article

The analgesic efficacy and safety of peri-articular injection versus intra-articular injection in one-stage bilateral total knee arthroplasty: a randomized controlled trial