The effect of magnesium sulfate on postoperative pain in patients undergoing major abdominal surgery under remifentanil-based anesthesia

Lee, Cheol;Jang, Mi-Soon;Song, Yoon-Kang;O, Se-Ri;Moon, Seo-Young;Kang, Dong-Baek;Kim, Byoung-Ryun;Byun, Seung-Jae

  • Published : 20080900

Abstract

Background: Opioid tolerance may involve activation of the N-methyl-D-aspartate (NMDA) system. The possible involvement of the NMDA system suggests that one of the NMDA receptor antagonists, magnesium may be a useful adjunct to opioids for the treatment of postoperative pain following remifentanil infusion. Methods: For this study, 70 patients scheduled for major abdominal surgery under remifentanil-based anesthesia were randomly allocated into groups that received either magnesium sulfate (group M) or saline (group C) intravenously. The patients in the group M received 25% magnesium sulfate at a dose of 50 mg/kg in 100 ml of saline, and those in the group C received an equal volume of saline prior to the induction of anesthesia. In addition, patients in both groups received 10 mg/kg/h infusion of either magnesium sulfate (group M) or an equal volume of saline (group C) until the end of surgery. Pain was assessed using a visual analog scale at 30 min, and 6, 12, 24, and 36 hours after operation. The time to the first use of postoperative analgesic and cumulative analgesic consumption in both groups were also evaluated. Results: The visual analog scale scores for pain and cumulative analgesic consumption were significantly lower in the group M than in the group C. The time to the first use of postoperative analgesic was significantly shorter in group C than in the group M. Conclusions: Use of the NMDA-receptor antagonist, magnesium sulfate as an adjuvant analgesic reduced postoperative pain in patients undergoing major abdominal surgery under remifentanil-based anesthesia.

Keywords

References

  1. Thompson JP, Rowbotham DJ: Remifentanil: An opioid for the 21st century. Br J Anaesth 1996; 76: 341-3. https://doi.org/10.1093/bja/76.3.341
  2. Dershwitz M, Randel GI, Rosow CE, Fragen RJ, Connors PM, Librojo ES, et al: Initial clinical experience with remifentanil, a new opioid metabolized by esterases. Anesth Analg 1995; 81: 619-23. https://doi.org/10.1097/00000539-199509000-00035
  3. Fletcher D, Pinaud M, Scherpereel P, Clyti N, Chauvin M: Efficacy of 0.15 mg/kg versus 0.25 mg/kg intraoperative morphine for immediate postoperative analgesia after remifentanil-based anesthesia for major surgery. Anesth Analg 2000; 90: 666-71. https://doi.org/10.1097/00000539-200003000-00029
  4. Telci L, Esen F, Akcora D, Erden T, Canbolat AT, Akpir K: Evaluation of effects of magnesium sulphate in reducing intraoperative anaesthetic requirements. Br J Anaesth 2002; 89: 594-8. https://doi.org/10.1093/bja/aef238
  5. Ryu JH, Kang MH, Park KS, Do SH: 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. https://doi.org/10.1093/bja/aem407
  6. Woolf CJ, Thompson SW: The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain 1991; 44: 293-9. https://doi.org/10.1016/0304-3959(91)90100-C
  7. Storm W, Zimmerman JJ: Magnesium deficiency and cardiogenic shock after cardiopulmonary bypass. Ann Thorac Surg 1997; 64: 572-7. https://doi.org/10.1016/S0003-4975(97)00460-8
  8. Place HM, Enzenauer RJ, Muff BJ, Ziporin PJ, Brown CW: Hypomagnesemia in postoperative spine fusion patients. Spine 1996 21: 2268-72. https://doi.org/10.1097/00007632-199610010-00018
  9. Shiga T, Wajima Z, Inoue T, Ogawa R: Magnesium prophylaxis for arrhythmias after cardiac surgery: a meta-analysis of randomized controlled trials. Am J Med 2004; 117: 325-33. https://doi.org/10.1016/j.amjmed.2004.03.030
  10. Rubeiz GJ, Thill-Baharozian M, Hardie D, Carlson RW: Association of hypomagnesemia and mortality in acutely ill medical patients. Crit Care Med 1993; 21: 203-9. https://doi.org/10.1097/00003246-199302000-00010
  11. Whang R: Magnesium deficiency: Pathogenesis, prevalence, and clinical implications. Am J Med 1987; 82: 24-9. https://doi.org/10.1016/0002-9343(87)90129-X
  12. Lanzinger MJ, Moretti EW, Wilderman RF, El-Moalem HE, Toffaletti JG, Moon RE: The relationship between ionized and total serum magnesium concentrations during abdominal surgery. J Clin Anesth 2003; 15: 245-9. https://doi.org/10.1016/S0952-8180(03)00059-X
  13. Chang CH, Nam SB, Lee JS, Han DW, Lee HK, Shin CS: Change in ionzed and total magnesium concentration during spinal surgery. Korean J Anesthesiol 2007; 52: S 37-41. https://doi.org/10.4097/kjae.2007.52.6.S37
  14. Nowak L, Bregestovski P, Ascher P, Herbet A, Prochiantz A: Magnesium gates glutamate-activated channels in mouse central neurones. Nature 1984; 307: 462-5. https://doi.org/10.1038/307462a0
  15. Koinig H, Wallner T, Marhofer P, Andel H, Horauf K, Mayer N: Magnesium sulphate reduces intra- and postoperative analgesic requirements. Anesth Analg 1998; 87: 206-10. https://doi.org/10.1097/00000539-199807000-00042
  16. Levaux CH, Bonhomme V, Dewandre PY, Brichant JF, Hans P: Effect of intraoperative magnesium sulphate on pain relief and patient comfort after lumbar orthopaedic surgery. Anaesthesia 2003; 58: 131-5. https://doi.org/10.1046/j.1365-2044.2003.02999.x
  17. Bahar M, Cohen ML, Grinshpun Y, Datski R, Kaufman J, Zaidman JL, et al: Serum electrolyte and blood gas changes after intrathecal and intravenous bolus injections of magnesium sulphate. Anaesthesia 1997; 52: 1065-9. https://doi.org/10.1111/j.1365-2044.1997.218-az0352.x
  18. Zarauza R, Saez-Fernandez AN, Iribarren MJ, Carrascosa F, Adame M, Fidalgo I, et al: A comparable study with oral nimodipine and magnesium sulphate in postoperative analgesia. Anesth Analg 2000; 91: 938-43. https://doi.org/10.1097/00000539-200010000-00032
  19. Wilder-Smith CH, Knöpfli R, Wilder-Smith OH: Perioperative magnesium infusion and postoperative pain. Acta Anaesthesiol Scand 1997; 41: 1023-7. https://doi.org/10.1111/j.1399-6576.1997.tb04830.x
  20. McCarthy RJ, Kroin JS, Tuman KJ, Penn RD, Ivankovich AD: Antinociceptive potentiation and attenuation of tolerance by intrathecal co-infusion of magnesium sulfate and morphine in rats. Anesth Analg 1998; 86: 830-6. https://doi.org/10.1097/00000539-199804000-00028
  21. Goto T, Marota JJ, Crosby G: Volatile anaesthetics antagonize nitrous oxide and morphine-induced analgesia in the rat. Br J Anaesth 1996; 76: 702-6. https://doi.org/10.1093/bja/76.5.702
  22. Tomi K, Mashimo T, Tashiro C, Yagi M, Pak M, Nishimura S, et al: Alterations in pain threshold and psychomotor response associated with subanaesthetic concentrations of inhalation anaesthetics in humans. Br J Anaesth 1993; 70: 684-6. https://doi.org/10.1093/bja/70.6.684
  23. Petersen-Felix S, Arendt-Nielsen L, Bak P, Roth D, Fischer M, Bjerring P, et al: Analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by experimental induced pain. Br J Anaesth 1995; 75: 55-60. https://doi.org/10.1093/bja/75.1.55
  24. Galinkin JL, Janiszewski D, Young CJ, Klafta JM, Klock PA, Coalson DW, et al: Subjective, psychomotor, cognitive, and analgesic effects of subanesthetic concentration of sevoflurane and nitrous oxide. Anesthesiology 1997; 87: 1082-8. https://doi.org/10.1097/00000542-199711000-00012
  25. Wadhwa A, Sengupta P, Durrani J, Akça O, Lenhardt R, Sessler DI, et al: Magnesium sulphate only slightly reduces the shivering threshold in humans. Br J Anaesth 2005; 94: 756-62. https://doi.org/10.1093/bja/aei105
  26. Kranke P, Eberhart LH, Roewer N, Tramèr MR: Single-dose parenteral pharmacological interventions for the prevention of postoperative shivering: a quantitative systematic review of randomized controlled trials. Anesth Analg 2004; 99: 718-27. https://doi.org/10.1213/01.ANE.0000130589.00098.CD