• Anesthesia
• Cardiac surgery
• Intravenous
• Magnesium
• Shivering

• magnesium sulfate
• meta-analysis
• multimodal
• opioid consumption
• pain
• spinal surgery

• Electrical stimulus
• Epidural, horse
• Magnesium sulphate
• Mechanical stimulus
• Thermal stimulus

• Horses
• Animals
• Magnesium Sulfate/pharmacology
• Epidural Space
• Anesthesia, Epidural/veterinary
• Heart Rate
• Analgesics/pharmacology

• Cataract surgery
• efficiency
• safety
• sub-Tenon anesthesia
• surgeon satisfaction

• GI endoscopy
• ketamine
• magnesium sulfate
• midazolam
• patient satisfaction
• propofol.
• sedation

• Analgesia, epidural
• Magnesium sulfate, therapeutic use
• Pain, postoperative

The purpose of this study was to summarize and evaluate evidence on the effectiveness of perioperative magnesium as an adjuvant for postoperative analgesia. We conducted an umbrella review of the evidence across systematic reviews and meta-analyses of randomized controlled trials (RCTs) on the effect of perioperative magnesium on pain after surgical procedures. Two independent investigators retrieved pain-related outcomes and assessed the methodological quality of the evidence of included studies using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) tool, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. In addition, an updated meta-analysis of postoperative pain-related outcomes with a trial sequential analysis (TSA) was conducted. Of the 773 articles initially identified, 17 systematic reviews and meta-analyses of 258 RCTs were included in the current umbrella review. Based on the AMSTAR tool, the overall confidence of the included systematic reviews was deemed critically low to low. Pain score, analgesic consumption, time to first analgesic request, and incidence of analgesic request were examined as pain-related outcomes. According to the GRADE system, the overall quality of evidence ranged from very low to moderate. While the updated meta-analysis showed the beneficial effect of perioperative magnesium on postoperative analgesia, and TSA appeared to suggest sufficient existing evidence, the heterogeneity was substantial for every outcome. Although the majority of included systematic reviews and updated meta-analysis showed a significant improvement in outcomes related to pain after surgery when magnesium was administered during the perioperative period, the evidence reveals a limited confidence in the beneficial effect of perioperative magnesium on postoperative pain.

• analgesia
• magnesium
• meta-analysis
• pain
• postoperative
• systematic review
• umbrella review

• Bilateral inguinal herniorrhaphy
• Dexmedetomidine
• Magnesium sulphate
• Spinal anesthesia

The use of local anesthesia has been proved to be beneficial in ear surgeries.

This study was conducted to compare between local anesthesia alone and in combination with magnesium sulphate as an adjuvant in ear operations.

This prospective study included a total of 164 cases prepared for elective ear surgeries were included. They were divided into two equal groups, group C or control group included cases who received local anesthesia alone, and group M which included cases who received local anesthesia in addition to magnesium sulphate. Ear ring block was performed in all cases. Monitoring of blood pressure, heart rate, and oxygen saturation was performed. Post-operative pain was assessed by visual analogue score. The total analgesic time and total analgesic requirement were recorded.

IBM's SPSS statistics (Statistical Package for the Social Sciences) for windows (version 25, 2017) was used for statistical analysis of the collected data. Shapiro-Wilk test was used to check the normality of the data distribution. All tests were conducted with 95% confidence interval. P (probability) value < 0.05 was considered statistically significant. Charts were generated using SPSS’ chart builder and Microsoft Excel for windows 2019.

The onset of sensory blockade was significantly earlier in the Mg group. Mg group showed a significant decrease in intraoperative and post-operative analgesic consumption. In addition, the first request for analgesia after operation was markedly delayed in the Mg group compared to controls. Regarding intraoperative VAS, it was significantly lower in the Mg group compared to controls at 15-minute reading. Post-operative VAS was significantly lower in Mg group during the first two hours.

Addition of magnesium to local anesthesia causes early onset of sensory blockade, delayed call first for analgesia, and better VAS scores during the early post-operative period.

• Adjuvants
• ear surgery
• local anesthesia
• magnesium sulfate

• Dysmagnesemia
• ICU
• Ionised Magnesium
• Preoperative Medicine

A crucial element in the systematic review (SR) methodology is the appraisal of included primary studies, using tools for assessment of methodological quality or risk of bias (RoB). SR authors can conduct sensitivity analyses to explore whether their results are sensitive to exclusion of low quality studies or a high RoB. However, it is unknown which tools do SR authors use for assessing quality/RoB, and how they set threshold for quality/RoB in sensitivity analyses. The aim of this study was to assess quality/RoB assessment tools, the types of sensitivity analyses and quality/RoB thresholds for sensitivity analyses used within SRs published in high-impact pain/anesthesiology journals.

This was a methodological study. We analyzed SRs published from January 2005 to June 2018 in the 25% highest-ranking journals within the Journal Citation Reports (JCR) “Anesthesiology” category. We retrieved the SRs from PubMed. Two authors independently screened records, full texts, and extracted data on quality/RoB tools and sensitivity analyses. We extracted data about quality/RoB tools, types of sensitivity analyses and the thresholds for quality/RoB used in them.

Out of 678 analyzed SRs, 513 (76%) reported the use of quality/RoB assessments. The most commonly reported tools for assessing quality/RoB in the studies were the Cochrane tool for risk of bias assessment (N = 251; 37%) and Jadad scale (N = 99; 15%). Meta-analysis was conducted in 451 (66%) of SRs and sensitivity analysis in 219/451 (49%). Most commonly, sensitivity analysis was conducted to explore the influence of study quality/RoB (90/219; 41%) on the results. Quality/RoB thresholds used for sensitivity analysis for those studies were clearly reported in 47 (52%) articles that used them. The quality/RoB thresholds used for sensitivity analyses were highly heterogeneous and inconsistent, even when the same tool was used.

A quarter of SRs reported using quality/RoB assessments, and some of them cited tools that are not meant for assessing quality/RoB. Authors who use quality/RoB to explore the robustness of their results in meta-analyses use highly heterogeneous quality/RoB thresholds in sensitivity analyses. Better methodological consistency for quality/RoB sensitivity analyses is needed.

• Bias
• Quality assessment
• Sensitivity analysis
• Systematic review

• Administration, Topical
• Adult
• Airway Extubation/adverse effects
• Airway Extubation/methods
• Anesthesia, General/methods
• Humans
• Intubation, Intratracheal/adverse effects
• Intubation, Intratracheal/methods
• Magnesium Sulfate/administration & dosage
• Pharyngitis/etiology
• Pharyngitis/prevention & control
• Postoperative Complications/prevention & control
• Randomized Controlled Trials as Topic

Magnesium is a physiological antagonist of NMDA receptor and a calcium channel blocker. This study was designed to test the analgesic effect of magnesium sulfate (MgSO₄) when added to epidural anesthesia in mild pre-eclampsia.

Sixty parturients with mild pre-eclampsia were allocated randomly to two equal groups. The Placebo group received 20 ml levobupivacaine hydrochloride 0.5% plus 5 ml isotonic saline 0.9% using two separate syringes. The Magnesium group received the same amount of local anesthetic plus 5 ml of 10% MgSO₄(500 mg) using two separate syringes. The primary outcome was pain free period. While, the secondary outcomes were the onset of motor block and the time needed to achieve complete motor block. The analgesic profile was evaluated by visual analog scale (VAS) during rest or motion, the time to first request for analgesia, and the total analgesic consumption.

The pain-free period was significantly longer in the Magnesium group (311.3 ± 21.4) compared to placebo group (153.1 ± 22.18). The total postoperative consumption of fentanyl was significantly lower in the Magnesium group (42.4 ± 5.3) than that in the placebo group (94.4 ± 9.9), with a P value 0. 01. Both the onset time of motor block and the time needed to achieve complete motor block were significantly shorter among the Magnesium group (4.4 ± 1.4 and 8.2 ± 0.4, respectively), with a P value of 0. 01.

The addition of 500 mg MgSO₄ to epidural anesthesia fastens both sensory and motor blockade and improves postoperative analgesic profile.

• Epidural anesthesia
• levobupivacaine
• magnesium

Magnesium sulfate and midazolam have been used as adjuvants to local anesthetics via intrathecal and epidural routes to augment the quality of block and prolong postoperative analgesia. This study compares addition of intrathecal magnesium sulfate versus intrathecal midazolam to epidurally administered isobaric ropivacaine as a part of combined spinal epidural technique in pre-eclamptic parturients undergoing elective cesarean section.

After institutional ethics committee approval and written informed consent, 50 pre-eclamptic parturients were randomly allocated to one of the two groups of 25 each to either receive intrathecal magnesium sulfate (50 mg) or intrathecal midazolam (1 mg) in combination with epidural ropivacaine (0.75%; 14–16 ml). The onset and duration of sensory and motor blockade, duration of postoperative analgesia, postoperative visual analogue scores for pain, and perioperative side effects were noted. Data were analyzed statistically using Graphpad.com software.

Onset times to sensory and motor blockade were faster in midazolam than in magnesium group (P < 0.01). Duration of sensory and motor blockade, and time to first request of analgesia were significantly longer in the magnesium group compared to the midazolam group (P < 0.01). The fetal outcomes according to APGAR scores were comparable in both the groups, the median APGAR score at 1 minute was 8 and at 5 minutes was 10 in both the groups.

Intrathecal magnesium with epidural ropivacaine significantly prolonged postoperative analgesia compared to intrathecal midazolam without any complications. Perioperative hemodynamics were comparable in both groups.

• Combined spinal epidural anesthesia
• magnesium sulfate
• midazolam hydrochloride
• pre-eclampsia
• pregnancy

• Emergency room
• ketamine
• magnesium sulfate
• procedural sedation and analgesia

• Anesthesia, Caudal/methods
• Anesthetics, Local/administration & dosage
• Child
• Child, Preschool
• Humans
• Infant
• Magnesium/administration & dosage
• Pain, Postoperative/drug therapy
• Randomized Controlled Trials as Topic
• Surgical Procedures, Operative/adverse effects

Although beneficial in acute and chronic pain management, the use of local anaesthetics is limited by its duration of action and the dose dependent adverse effects on the cardiac and central nervous system. Adjuvants or additives are often used with local anaesthetics for its synergistic effect by prolonging the duration of sensory-motor block and limiting the cumulative dose requirement of local anaesthetics. The armamentarium of local anesthetic adjuvants have evolved over time from classical opioids to a wide array of drugs spanning several groups and varying mechanisms of action. A large array of opioids ranging from morphine, fentanyl and sufentanyl to hydromorphone, buprenorphine and tramadol has been used with varying success. However, their use has been limited by their adverse effect like respiratory depression, nausea, vomiting and pruritus, especially with its neuraxial use. Epinephrine potentiates the local anesthetics by its antinociceptive properties mediated by alpha-2 adrenoreceptor activation along with its vasoconstrictive properties limiting the systemic absorption of local anesthetics. Alpha 2 adrenoreceptor antagonists like clonidine and dexmedetomidine are one of the most widely used class of local anesthetic adjuvants. Other drugs like steroids (dexamethasone), anti-inflammatory agents (parecoxib and lornoxicam), midazolam, ketamine, magnesium sulfate and neostigmine have also been used with mixed success. The concern regarding the safety profile of these adjuvants is due to its potential neurotoxicity and neurological complications which necessitate further research in this direction. Current research is directed towards a search for agents and techniques which would prolong local anaesthetic action without its deleterious effects. This includes novel approaches like use of charged molecules to produce local anaesthetic action (tonicaine and n butyl tetracaine), new age delivery mechanisms for prolonged bioavailability (liposomal, microspheres and cyclodextrin systems) and further studies with other drugs (adenosine, neuromuscular blockers, dextrans).

• Local anesthetics
• Adjuvants
• Neurotoxicity
• Opioids
• Ketamine
• Midazolam
• Alpha-2 adrenoreceptor antagonists

Surgeon satisfaction and patient analgesia during the procedure of laparoscopic surgery are important issues. The aim of this work was to study if an intrathecal (IT) Bupivacaine combined with Magnesium sulfate may or may not provide good surgeon satisfaction in addition to improvement of intraoperative and postoperative analgesia.

Sixty female patients were enrolled in this prospective, randomized, double-blind controlled clinical trial study. All patients were operated for gynecological laparoscopic surgery under spinal anesthesia. Patients were divided into two groups (Bupivacaine and Magnesium). Group Bupivacaine (30 patients) received intrathecal Bupivacaine 0.5% only (15 mg), while 30 patients in group Magnesium received intrathecal Bupivacaine (15 mg) in addition to intrathecal Magnesium sulfate (50 mg). The sensory block level, the intensity of motor block, the surgeon satisfaction, the intraoperative visual analog scale (VAS) for pain assessment, the postoperative VAS, and side effects were recorded during the intraoperative period and within the first 24 hours after surgery in the post-anesthesia care unit.

Surgeon satisfaction, intraoperative shoulder pain, postoperative pain after 2 h, and perioperative analgesic consumption (ketorolac) were significant better in group Magnesium than in group Bupivacaine. (P < 0.05). The onset of motor and sensory blocks was significant longer in group Magnesium than the other one. The incidence of PONV, pruritus and urinary retention was insignificant statistically between both groups.

Magnesium sulfate if used intrathecally as an adjuvant to Bupivacaine would provide a better surgeon satisfaction and would improve the analgesic effect of spinal anesthesia used for gynecological laparoscopic surgery.

• Bupivacaine
• Laparoscopic surgery
• Magnesium
• Postoperative pain
• Satisfaction
• Surgeon

Addition of intrathecal magnesium sulfate to local anesthetics has been reported to potentiate spinal anesthesia and prolong analgesia in parturients. The current study was to determine whether intrathecal magnesium sulfate would reduce the dose of hyperbaric bupivacaine in spinal anesthesia with bupivacaine and sufentanil for cesarean delivery.

Sixty healthy parturients undergoing scheduled cesarean delivery were randomly assigned to receive spinal anesthesia with 0.5% hyperbaric bupivacaine and 5 μg sufentanil with either 0.9% sodium chloride (Control group) or 50% magnesium sulfate (50 mg) (Magnesium group). Effective anesthesia was defined as a bilateral T₅ sensory block level achieved within 10 min of intrathecal drug administration and no additional epidural anesthetic was required during surgery. Characteristic of spinal anesthesia and the incidence of side effects were observed. The ED₅₀ for both groups was calculated using the Dixon and Massey formula.

There was no significant difference in the ED₅₀ of bupivacaine between the Magnesium group and the Control group (4.9 mg vs 4.7 mg) (P = 0.53). The duration of spinal anesthesia (183 min vs 148 min, P < 0.001) was longer, the consumption of fentanyl during the first 24 h postoperatively (343 μg vs 550 μg, P < 0.001) was lower in the Magnesium group than that in the Control group.

Intrathecal magnesium sulfate (50 mg) did not reduce the dose requirement of intrathecal bupivacaine, but can extend the duration of spinal anesthesia with no obvious additional side effects.

This study was registered with Chinese Clinical Trial Registry (ChiCTR) on 15 Jul. 2014 and was given a trial ID number ChiCTR-TRC-14004954.

• Anesthesia
• Cesarean delivery
• Magnesium sulfate
• Spinal

Use of various adjuvants to spinal anaesthesia is a well-known modality to provide intra- and post-operative analgesia. This study was designed to evaluate and compare the analgesic efficacy of clonidine and magnesium when used as an additive to intrathecal 0.5% hyperbaric bupivacaine.

Ninety patients of the American Society of Anesthesiologists’ physical status grade I or II, scheduled for lower abdominal surgery under spinal anaesthesia, were randomly allocated into three groups. Group B received 3 mL of 0.5% hyperbaric bupivacaine with 1 mL of normal saline, Group C received 3 mL of 0.5% hyperbaric bupivacaine with 1 mL (30 μg) of clonidine and Group M received 3 mL of 0.5% hyperbaric bupivacaine with 1 mL (50 mg) magnesium sulphate. The primary outcome variable was duration of analgesia and secondary outcome variables included onset and duration of sensory and motor block, sedation level and adverse effects. Data were analysed with ANOVA, Kruskal–Wallis and Chi-square tests.

The time to first rescue analgesia was significantly (P < 0.01) longer in the Group C (330.7 ± 47.7 min) than both Groups. Group M (246.3 ± 55.9 min) showed significantly prolonged analgesia than Group B (134.4 ± 17.9 min). Group C and Group M showed significantly prolonged duration of both sensory and motor block compared to Group B.

Intrathecal clonidine added to bupivacaine prolongs the duration of post-operative analgesia, and hastens the onset and prolongs the duration of sensory and motor block compared to magnesium or controls.

• Bupivacaine
• clonidine
• magnesium
• post-operative analgesia

• Anesthesia
• Magnesium
• Obstetrical

Spinal anaesthesia is used for many years for surgeries below the level of umbilicus. It has certain disadvantages such as limited duration of blockade and post-operative analgesia. This study was undertaken to evaluate the effects of additives fentanyl and magnesium sulphate along with bupivacaine during spinal anaesthesia for prolongation of analgesia and motor blockade.

This randomised study was conducted in 120 patients of either sex of American Society of Anesthesiologists physical status I and II, posted for infraumbilical surgeries. Patients were randomly allocated to four groups and were given the following drugs intrathecally as per group distribution; group A - bupivacaine 15 mg (0.5% heavy) with fentanyl 25 μg, group B - bupivacaine 15 mg (0.5% heavy) with magnesium 100 mg, group C - bupivacaine 15 mg (0.5% heavy) with magnesium 50 mg and group D - bupivacaine 15 mg (0.5% heavy) with 0.5 ml normal saline. Parameters monitored were duration of analgesia along with haemodynamic parameters and side effects. Data were analysed using the Student's t-test for the continuous variables and two-tailed Fisher exact test or Chi-square test for categorical variables.

There was significant increase in duration of analgesia in group A (374.37 min) and B (328.13 min) as compared to group C (274.87 min) and D (246.03 min). In group A, all haemodynamic parameters decreased by more than 20%, compared to baseline parameters, which was clinically and statistically significant as compared to other groups. There was also increase in duration of motor blockade in groups A and B.

Addition of magnesium sulphate at 100 mg dose or fentanyl 25 μg as adjuvants to intrathecal bupivacaine significantly prolongs the duration of analgesia, though in the given doses, magnesium provides better haemodynamic stability than fentanyl, with fewer side effects.

• Bupivacaine
• intrathecal fentanyl
• intrathecal magnesium sulphate
• spinal adjuvant

• adjuvant
• analgesia
• anesthesia
• caudal
• magnesium

• Accidental
• cesarean section
• intrathecal
• magnesium sulfate

• Anaesthesia duration
• Local anaesthetic
• Magnesium
• Opioid
• Spinal

• analgesia
• postoperative care

Magnesium sulfate has been used in preeclampsia patients in order to prevent seizure. It is also used for the treatment of arrhythmia and asthma and as an anesthetic adjunct in patients undergoing surgery for pheochromocytoma. However, its potentiating effects on perioperative analgesia and muscle relaxation have drawn attention recently. These characteristics of magnesium (anesthetic- and analgesic-sparing effect) enable anesthesiologists to reduce the use of anesthetics during surgery and the use of analgesics after surgery. Magnesium sulfate has a high therapeutic index and cost-effectiveness. Considering these diverse characteristics useful for anesthesia, appropriate use of magnesium sulfate would improve surgical outcome and patients' satisfaction.

• Analgesia
• Magnesium
• Magnesium sulfate
• Muscle relaxation