Safety and Efficacy of Perioperative Magnesium Sulfate Injection for Postoperative Pain Management and Opioid Sparing Effects in Surgeries of the Nervous System: A Systematic Review and Meta Analysis.

BACKGROUND

Postoperative pain following spinal and neurological surgeries is often severe and can hinder recovery, mobilization, and increase risk of chronic pain. While opioids are the traditional standard for pain management, associated risks and the ongoing opioid crisis necessitate alternative therapies. Magnesium sulfate, an NMDA receptor antagonist and calcium channel blocker, has shown promise in reducing postoperative pain and opioid consumption.

METHODS

The present investigation utilized a systematic search for studies from PubMed, Embase, and Web of Science. Sources were eligible for inclusion in this review if published from 2010 to present, if patients received a spinal or neurological surgery regardless of patient age, country, race, and gender, and if the source was a randomized control trial, case report, or case series. Sources in non-English, without full-text access, and systematic reviews/meta-analyses were excluded, as well as studies focused on non-human subjects or studies with adjuvant therapies. Nine randomized controlled trials met our criteria. Pain scores (VAS/NRS) and opioid consumption were the primary outcomes. Meta-analysis was conducted using Cochrane Review Manager with fixed or random-effects models depending on heterogeneity.

RESULTS

Magnesium sulfate significantly reduced pain scores at rest at multiple postoperative time points, including 0 h (MD=- 0.79; p = 0.004), 4 h (MD= -1.03, p < 0.00001), 24 h (MD= -0.78: p = 0.005), and 48 h (MD= -0.67: p = 0.0006). Opioid consumption was also significantly reduced at various intervals. No major adverse events were reported.

CONCLUSION

Perioperative magnesium sulfate infusion is a safe and effective adjunct for reducing postoperative pain and opioid use in spinal surgery patients, with potential applications in neurological procedures pending further research.