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Archives of Academic Emergency Medicine 2023There has been growing interest in the potential role of adjunctive magnesium sulfate in improving pain management. This systematic review and meta-analysis aimed to...
INTRODUCTION
There has been growing interest in the potential role of adjunctive magnesium sulfate in improving pain management. This systematic review and meta-analysis aimed to assess the effect of intra-operative adjunctive magnesium sulfate on pain management and opioid consumption in total knee arthroplasty (TKA).
METHODS
A comprehensive search was conducted in Medline, Embase, Scopus, Web of Science, and Cochrane Library databases, covering studies up to April 2023. The extracted data included pain management outcomes, opioid consumption, and adverse effects from the selected studies. Standardized mean differences (SMDs) were calculated for continuous outcomes, while risk ratios (RRs) were calculated for dichotomous outcomes. Meta-analysis was conducted employing random-effects models in STATA 17.
RESULTS
In this meta-analysis of 8 randomized controlled trials involving 536 patients, adjunctive magnesium sulfate in TKA was found to significantly reduce opioid consumption during the first 24 hours after operation (SMD: -1.88, 95% confidence interval (CI): [-3.66 to -0.10]; p = 0.038). It also resulted in lower pain scores at rest 24 hours after surgery (SMD: -1.53, 95% CI: [-2.70 to -0.37]; p = 0.010). There were no significant differences in time to first rescue analgesic and adverse effects between the groups. The included studies were assessed to have low to high levels of risk of bias.
CONCLUSION
This study presents evidence at low to moderate levels supporting the use of intra-operative adjunctive magnesium sulfate in TKA for improved pain management and reduced opioid consumption. However, further research is needed to address the heterogeneity and to explore optimal dosing regimens and routes of administration to maximize the benefits of magnesium sulfate in TKA.
PubMed: 37671273
DOI: 10.22037/aaem.v11i1.2058 -
Medical Science Monitor : International... Oct 2023Eclampsia seizure is an always serious and potentially fatal obstetric condition. Safe delivery in women with pregnancies complicated by eclampsia seizures is still one... (Review)
Review
Eclampsia seizure is an always serious and potentially fatal obstetric condition. Safe delivery in women with pregnancies complicated by eclampsia seizures is still one of the greatest challenges in perinatal medicine. Pregnancy should be terminated (childbirth) in the safest and least traumatic way possible. Attempting vaginal delivery can take place only exceptionally, in the event of possibly quick completion of childbirth with a stable state of the mother and the fetus. However, immediate labor via cesarean section is most often recommended. It is essential to maintain left lateral patient positioning during cesarean section. Regional anesthesia can be used only in conscious patients who are free from coagulopathy and from HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome to decrease the risk of aspiration and failed intubation attempts in preeclamptic or eclamptic women. For sudden, unexpected interventions, when a patient arrives at the hospital with an eclampsia seizure without lab results, general anesthesia can be the best option and should be performed by an experienced medical team of anesthesiologists, ready to perform difficult intubation. Magnesium sulfate is the drug that should be used first to stop eclamptic convulsions and prevent their recurrence. Intravenous antihypertensive drugs can stabilize elevated blood pressure (BP), preventing multiorgan failure and recurrent eclampsia seizure, and thus the prevention of maternal death. This article aims to review the management of seizures during pregnancy in women with eclampsia to ensure safe delivery.
Topics: Female; Humans; Pregnancy; Cesarean Section; Eclampsia; HELLP Syndrome; Pre-Eclampsia; Seizures
PubMed: 37803822
DOI: 10.12659/MSM.941709 -
BMJ Open Jul 2023Antenatal maternal magnesium sulfate (MgSO) administration is a proven efficacious neuroprotective treatment reducing the risk of cerebral palsy (CP) among infants born...
INTRODUCTION
Antenatal maternal magnesium sulfate (MgSO) administration is a proven efficacious neuroprotective treatment reducing the risk of cerebral palsy (CP) among infants born preterm. Identification of the neuroprotective component with target plasma concentrations could lead to neonatal treatment with greater efficacy and accessibility.
METHODS AND ANALYSIS
This is a prospective observational cohort study, in three tertiary Australian centres. Participants are preterm infants, irrespective of antenatal MgSO exposure, born in 2013-2020 at 24 to 31 weeks gestation, and followed up to 2 years corrected age (CA) (to September 2023). 1595 participants are required (allowing for 17% deaths/loss to follow-up) to detect a clinically significant reduction (30% relative risk reduction) in CP when sulfate concentration at 7 days of age is 1 SD above the mean.A blood sample is collected on day 7 of age for plasma sulfate and magnesium measurement. In a subset of participants multiple blood and urine samples are collected for pharmacokinetic studies, between days 1-28, and in a further subset mother/infant blood is screened for genetic variants of sulfate transporter genes.The primary outcome is CP. Surviving infants are assessed for high risk of CP at 12-14 weeks CA according to Prechtl's Method to assess General Movements. Follow-up at 2 years CA includes assessments for CP, cognitive, language and motor development, and social/behavioural difficulties.Multivariate analyses will examine the association between day 7 plasma sulfate/magnesium concentrations with adverse neurodevelopmental outcomes. A population pharmacokinetic model for sulfate in the preterm infant will be created using non-linear mixed-effects modelling.
ETHICS AND DISSEMINATION
The study has been approved by Mater Misericordiae Ltd Human Research Ethics Committee (HREC/14/MHS/188). Results will be disseminated in peer-reviewed journal publications, and provided to the funding bodies. Using consumer input, a summary will be prepared for participants and consumer groups.
Topics: Female; Humans; Infant; Infant, Newborn; Pregnancy; Australia; Cerebral Palsy; Cohort Studies; Fetal Growth Retardation; Infant, Extremely Premature; Infant, Premature, Diseases; Magnesium; Neuroprotective Agents; Observational Studies as Topic; Premature Birth; Sulfates
PubMed: 37451710
DOI: 10.1136/bmjopen-2023-076130 -
European Review For Medical and... Sep 2023The effects of preemptive magnesium sulfate (MgSO4) infusion on perioperative hemodynamics and postoperative analgesia in female patients who underwent mastectomy were... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The effects of preemptive magnesium sulfate (MgSO4) infusion on perioperative hemodynamics and postoperative analgesia in female patients who underwent mastectomy were evaluated.
PATIENTS AND METHODS
American Society of Anesthesiologists (ASA) I-II female patients aged 18 years and over who underwent mastectomy were randomized into 2 groups, including 34 individuals each. The study group (Group I) was given 50 mg/kg MgSO4 in 250 ml isotonic 30 minutes before the induction, and the control group (Group II) was given 250 ml of normal isotonic solution. Standardized anesthesia was applied. Perioperative oxygen saturation, mean arterial pressure (MAP), pulse (HR), sedation scores (ss) in the recovery unit, Verbal Numeric Rating Scale (VNRS), need for rescuer fentanyl, and analgesic needs in the surgical period were evaluated.
RESULTS
Demographic variables were similar. There was no statistical difference between the two groups in terms of the MAP, HR, and oxygen saturation values measured at entry, post-intubation, 15th, 30th, 45th, 60th minutes, and after extubation. There was a statistically significant difference between the two groups in terms of VNRS scores in the recovery unit and at the 2nd, 4th, 8th, and 12th hours during the postoperative surgical period (p=0.0001, 0.001, 0.001, 0.004, 0.021, respectively). The need for rescue analgesics in the first 2 hours of recovery was found to be lower in the study group (p=0.005). The need for postoperative analgesics in the surgical period was not statistically significant (p=0.1).
CONCLUSIONS
Preemptive use of MgSO4 reduces postoperative VNRS scores without affecting hemodynamic parameters during induction and maintenance of general anesthesia.
Topics: Humans; Female; Adolescent; Adult; Mastectomy; Magnesium Sulfate; Breast Neoplasms; Pain, Postoperative; Anesthesia, General
PubMed: 37750619
DOI: 10.26355/eurrev_202309_33549 -
Pakistan Journal of Medical Sciences 2024To observe the treatment of severe preeclampsia in newborns with enoxaparin sodium combined with magnesium sulfate.
OBJECTIVE
To observe the treatment of severe preeclampsia in newborns with enoxaparin sodium combined with magnesium sulfate.
METHODS
A retrospective analysis was conducted on the clinical data of 80 patients with severe preeclampsia admitted to Hefei Second People's Hospital, China from January 2019 to December 2020. Treatment records showed that 40 cases received magnesium sulfate treatment (single group), and 40 cases received enoxaparin sodium combined with magnesium sulfate treatment (combination group). Levels of D-dimer, soluble fms-like tyrosine kinase 1 (sFlt-1), (PLGF), Apgar scores of newborns delivered before and after treatment were compared. Gestation weeks and incidence of adverse reactions were analyzed.
RESULTS
After treatment, levels of D-dimer, sfit-1 and adverse reactions in the combination group were significantly lower than those in the single group (<0.05), and the level of PLGF, newborn Apgar score and length of gestation were significantly higher than those in the single group (<0.05).
CONCLUSION
Compared to magnesium sulfate alone, the combination of enoxaparin sodium and magnesium sulfate in the treatment of pregnant women with severe preeclampsia can more effectively regulate the cytokine level of patients, improve pregnancy outcome, and improve neonatal Apgar score. The incidence of adverse reactions is low, making it a safe and efficient treatment modality.
PubMed: 38827871
DOI: 10.12669/pjms.40.5.9001 -
Brazilian Journal of Anesthesiology... 2023This study evaluated the efficacy of epidurally administered magnesium associated with local anesthetics on postoperative pain control. (Review)
Review
BACKGROUND
This study evaluated the efficacy of epidurally administered magnesium associated with local anesthetics on postoperative pain control.
METHODS
The study protocol was registered in PROSPERO as CRD42021231910. Literature searches were conducted on Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing epidural administration of magnesium added to local anesthetics for postoperative pain in elective surgical adult patients. Primary outcomes were the time to the first Postoperative (PO) Analgesic Request (TFAR), 24-hour postoperative opioid consumption, and Visual Analog Scale (VAS) scores at the first six and 24 postoperative hours. Secondary outcomes included Postoperative Nausea and Vomiting (PONV), pruritus, and shivering. Quality of evidence was assessed using GRADE criteria.
RESULTS
Seventeen studies comparing epidural were included. Effect estimates are described as weighted Mean Differences (MD) and 95% Confidence Intervals (95% CI) for the main outcomes: TFAR (MD = 72.4 min; 95% CI = 10.22-134.58 min; p < 0.001; I = 99.8%; GRADE: very low); opioid consumption (MD = -7.2 mg (95% CI = -9.30 - -5.09; p < 0.001; I = 98%; GRADE: very low). VAS pain scores within the first six PO hours (VAS) (MD = -1.01 cm; 95% CI = -1.40-0.64 cm; p < 0.001; I = 88%; GRADE: very low), at 24 hours (MD = -0.56 cm; 95% CI = -1.14-0.01 cm; p = 0.05; I = 97%; GRADE: very low).
CONCLUSIONS
Magnesium sulfate delayed TFAR and decreased 24-hour opioid consumption and early postoperative pain intensity. However, imprecision and inconsistency pervaded meta-analyses, causing very low certainty of effect estimates.
Topics: Humans; Anesthetics, Local; Magnesium Sulfate; Analgesics, Opioid; Magnesium; Pain, Postoperative
PubMed: 36087812
DOI: 10.1016/j.bjane.2022.08.005 -
Local and Regional Anesthesia 2023Magnesium sulfate (MgSO4) may enhance the effects of local anesthetics when used as an adjuvant in peripheral nerve blocks. Our objective was to evaluate efficiency and...
Magnesium Sulfate in Pediatric Abdominal Cancer Surgery: Safety and Efficacy in Ultrasound-Guided Transversus Abdominis Plane (US-TAP) Block in Conjugation with Levobupivacaine.
PURPOSE
Magnesium sulfate (MgSO4) may enhance the effects of local anesthetics when used as an adjuvant in peripheral nerve blocks. Our objective was to evaluate efficiency and safety of utilizing MgSO4 alongside levobupivacaine in bilateral ultrasound-guided transversus abdominis plane (US-TAP) block for postoperative pain in pediatric cancer patients who underwent abdominal surgery.
METHODOLOGY
A randomized double-blinded controlled trial at South Egypt Cancer Institute, Assiut University, Assiut, Egypt, included that 40 pediatric patients with Wilms' tumor or neuroblastoma were randomly allocated to get bilateral (US-TAP) block and divided into two groups; M group: received US-TAP with 0.6 mL/kg levobupivacaine 0.25% + 2 mg/kg MgSO4 and C group: received with 0.6 mL/kg levobupivacaine 0.25% only. FLACC scores (Face, Leg, Activity, Cry, Consolability) were used to evaluate post-operative pain, first analgesic request, total analgesic consumption, adverse effects, as well as hemodynamics were monitored for 24 h and recorded at time points (2, 4, 6, 8, 12, 18, and 24h). Parent's satisfaction at discharge, also, was evaluated.
RESULTS
FLACC score in M group was significantly lower than in C group from 4 h to 24 h with the first analgesic request being longer (15.95 ± 1.99 vs 7.70 ± 0.80 (h); p < 0.001) and lower total analgesic consumption (231.75 ± 36.57 vs 576.00 ± 170.71 (mg); p < 0.001) when comparing M group to C group, respectively. Both groups had insignificant differences regarding hemodynamics, parent satisfaction, postoperative agitation, and side effects except vomiting occurred in two patients in the C group and one patient in the M group.
CONCLUSION
We conclude that adding magnesium sulphate as an adjuvant to local anaesthetic in US-TAP block for pain management in pediatric abdominal cancer surgeries resulted in better and longer analgesia, with less consumption of rescue analgesics with no serious side effects.
PubMed: 37719936
DOI: 10.2147/LRA.S425649 -
Medicine Nov 2023As per the American College of Obstetricians and Gynecologists in 2013, magnesium sulfate is the gold standard for the management of preeclampsia, but it has a short...
As per the American College of Obstetricians and Gynecologists in 2013, magnesium sulfate is the gold standard for the management of preeclampsia, but it has a short action time that does not provide stable maintenance of blood pressure. Labetalol is currently recommended as first-line treatment by the national UK guidance. This study included 355 pregnant Han Chinese women with preeclampsia and aimed to compare outcomes following intravenous magnesium compared with intravenous labetalol and oral nifedipine. Women received 4 g intravenous magnesium sulfate followed by the maintenance dose of 1 g/h intravenous magnesium sulfate (MS cohort, n = 104) or intravenous labetalol (LB cohort, n = 115), or oral nifedipine (NF cohort, n = 136). Therapy success: systolic blood pressure ~140 mm Hg and diastolic blood pressure ~90 mm Hg, therapy failure: persistent systolic blood pressure ≥ 160 or diastolic blood pressure ≥ 110 mm Hg after maximum dosage of therapy (EL). Women of all cohorts successfully decreased systolic and diastolic blood pressures at EL as compared to them before therapy conditions (P < .001, for all). At EL, systolic and diastolic blood pressures of women of the LB cohort decreased more than those of women of the MS and NF cohorts (P < .05, for all). Therapy was more successful in women of the LB cohort than those of the NF cohort (107 [93%] vs 112 [82%], P = .0132). More numbers of women were reduced blood pressure after 1 day of therapy from the LB cohort than those of the NF (75 [65%] vs 21 [15%]) and MS (75 [65%] vs 35 [34%]) cohorts (P < .0001 for both). Labetalol-induced tachycardia, bradycardia, and intracranial hemorrhage in pregnant women and respiratory distress syndrome and hypoglycemia in neonates. Intravenous labetalol provides proper reduction of blood pressure in Han Chinese women with preeclampsia but has the risk of undesirable maternal and neonatal adverse effects (Level of Evidence: IV; Technical Efficacy: Stage 4).
Topics: Female; Humans; Infant, Newborn; Pregnancy; Antihypertensive Agents; Blood Pressure; East Asian People; Hypertension; Labetalol; Magnesium Sulfate; Nifedipine; Pre-Eclampsia
PubMed: 37986315
DOI: 10.1097/MD.0000000000035334 -
Indian Journal of Anaesthesia Aug 2023Direct laryngoscopy and tracheal intubation cause an increase in heart rate (HR) and blood pressure, called as pressor response. This study aimed to compare nebulised...
Nebulised fentanyl, dexmedetomidine and magnesium sulphate for attenuation of haemodynamic response to laryngoscopy and tracheal intubation: A double-blinded, randomised comparative study.
BACKGROUND AND AIMS
Direct laryngoscopy and tracheal intubation cause an increase in heart rate (HR) and blood pressure, called as pressor response. This study aimed to compare nebulised forms of fentanyl, dexmedetomidine and magnesium sulphate to attenuate the haemodynamic response to laryngoscopy and tracheal intubation.
METHODS
This double-blinded, randomised study was conducted on 90 patients undergoing elective surgery requiring endotracheal intubation. Nebulisation was done with fentanyl 1 μg/kg (Group A), dexmedetomidine 1 μg/kg (Group B) and magnesium sulphate (MgSO) (40 mg/kg) (Group C). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and HR were recorded before nebulisation (T), post-nebulisation (T) and at 2, 5 and 10 min after intubation (T, T, T). The statistical analysis for comparing continuous variables between the groups was performed using analysis of variance (ANOVA), and a value <0.05 was considered statistically significant.
RESULTS
Compared to T, an increase in HR at T and T was seen in Group A only, which reached baseline values at T ( values <0.0001 and 0.037, respectively). No HR value was higher than the baseline readings in groups B and C. The decreasing trend of SBP, DBP and MAP was seen in all three groups. Groups B and C had a statistically significant decrease in all the values from baseline ( values <0.0001).
CONCLUSION
Nebulised form of dexmedetomidine (1 μg/kg) and magnesium (40 mg/kg) seems to be superior to fentanyl (1 μg/kg) in blunting the stress response to laryngoscopy and tracheal intubation.
PubMed: 37693019
DOI: 10.4103/ija.ija_397_22 -
American Journal of Translational... 2023To determine the efficacy of magnesium sulfate combined with nifedipine for pregnancy-induced hypertension syndrome (PIHS) and its influence on glucose and lipid...
OBJECTIVE
To determine the efficacy of magnesium sulfate combined with nifedipine for pregnancy-induced hypertension syndrome (PIHS) and its influence on glucose and lipid metabolism.
METHODS
The clinical data of 124 cases of PIHS treated in Jiangxi Jiujiang Maternal and Child Care Centers from March 2020 to June 2022 were collected and retrospectively analyzed. Among them, 58 patients who received magnesium sulfate alone were enrolled as a control group, and the other 66 given magnesium sulfate combined with nifedipine were enrolled as a study group. The two groups were compared for treatment efficacy, blood pressure, fasting blood glucose (FBG) and blood lipid indexes (triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), total cholesterol (TC), and low-density lipoprotein - cholesterol (LDL-C)). Multivariate logistic regression analysis was performed to analyze the factors affecting outcome.
RESULTS
The study group showed a significantly higher total effective rate than the control group (P=0.008). After treatment, the study group showed significantly lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels than the control group (P<0.001). After treatment, the study group also showed lower levels of FBG, TC, TG, and LDL-C and a higher HDL-C level than the control group (P<0.001). Additionally, the incidences of cesarean section and postpartum hemorrhage were lower in the study group than those of the control group (both P<0.05). The two groups were not significantly different in premature delivery or low neonatal birth weight (both P>0.05), and the incidence of adverse reactions of the two groups was also not greatly different (P>0.05). According to multivariate logistic regression analysis, higher BMI (OR: 3.087, 95% CI: 1.295~7.358) and higher SBP (OR: 1.220, 95% CI: 1.001~1.487) at admission were independent risk factors for poor efficacy, while combined therapeutic regimen (OR: 0.018, 95% CI: 0.001~0.228) was an independent protective factor.
CONCLUSION
Magnesium sulfate combined with nifedipine can deliver a powerful clinical efficacy for patients with PIHS by lowering blood pressure and the incidence of adverse pregnancy outcomes and by improving glucose and lipid metabolism.
PubMed: 37854216
DOI: No ID Found