Original Article

The Effect of Intravenous Infusion of Magnesium Sulfate During Bimaxillary Orthognathic Surgery on Post-operative Pain: A Clinical Trial

Abstract

Background: This prospective randomized controlled clinical study aimed to investigate the effect of magnesium sulfate (MgSO4) on pain management post orthognathic surgery.
Methods: In this study, 52 patients undergoing orthognatic surgery were randomly allocated to receive MgSO4 or saline intravenously. The intervention group (n = 26) received intravenous MgSO4 (30 mg/kg bolus for 15 minutes immediately before anesthesia induction followed by 10 mg/kg/h dissolved in saline via pump infusion) and the second group (n = 26) received the placebo in the same bolus volume as a normal saline in a 15 minute intravenous infusion which was continued until the end of the operation. A visual analog scale (VAS) was used to determine the intensity of pain. Invasive arterial blood pressure and valid and invalid analgesic demand were also recorded. Side effects were recorded, as well.
Results: This study was conducted on 52 patients, 26 per group. The results showed no statistically significant differences between the two groups with respect to demographics. During the post-operative period, the patients in the control group showed larger analgesic requirement 7 (26.9%) compared to those in the magnesium group 4 (15.4%) and the difference was not statistically significant (P = 0.308). The post-operative VAS scores evaluated serially from the recovery room also showed a significant difference between the intervention 3 (11.5%) and the control group 14 (53.8%) after the surgery (P = 0.001). However, no significant difference was found between the two groups regarding VAS scores in the surgical ward [7 (26.9%) vs. 8 (30.8%) P = 0.760].
Conclusions: Intra-operative administration of intravenous MgSO4 reduced opioid consumption for pain after bimaxillary orthognathic operations.

1. Kaur S, Baghla N. Evaluation of intravenous magnesium sulphate for postoperative analgesia in upper limb orthopaedic surgery under general anaesthesia: A comparative study. Internet J Anaesth. 2012; 30(2): 248-52.
2. Byrd RP Jr., Roy TM. Magnesium: its proven and potential clinical significance. South Med J. 2003; 96(1):104.
3. Seo JW, Park TJ. Magnesium metabolism. Electrolyte
Blood Press. 2008; 6(2): 86-95.
4. Iseri LT, French JH. Magnesium: nature's physiologic calcium blocker. Am Heart J. 1984; 108(1): 188-93.
5. Dube L, Granry JC. The therapeutic use of magnesium in
anesthesiology, intensive care and emergency medicine: a review. Can J Anaesth. 2003; 50(7): 732-46.
6. Konrad M, Schlingmann KP, Gudermann T. Insights into the molecular nature of magnesium homeostasis. Am J Physiol Renal Physiol. 2004; 286(4): F599-F605.
7. Alexander RT, Hoenderop JG, Bindels RJ. Molecular determinants of magnesium homeostasis: insights from human disease. J Am Soc Nephrol. 2008; 19(8): 1451-8.
8. Omote K, Sonoda H, Kawamata M, Iwasaki H, Namiki A. Potentiation of antinociceptive effects of morphine by calcium-channel blockers at the level of the spinal cord. Anesthesiology. 1993; 79(4): 746-52.
9. Lee DH, Kwon IC. Magnesium sulphate has beneficial effects as an adjuvant during general anaesthesia for Caesarean section. Br J Anaesth. 2009; 103(6): 861-6.
10. Ismail Y, Ismail AA, Ismail AA. The underestimated problem of using serum magnesium measurements to exclude magnesium deficiency in adults; a health warning is needed for "normal" results. Clin Chem Lab Med. 2010; 48(3): 323-7.

11. Kaya S, Kararmaz A, Gedik R, Turhanoglu S.
Magnesium sulfate reduces postoperative morphine requirement after remifentanil-based anesthesia. Med Sci Monit. 2009; 15(2): I5-I9.
12. Levaux C, Bonhomme V, Dewandre PY, Brichant JF, Hans P. Effect of intra-operative magnesium sulphate on pain relief and patient comfort after major lumbar orthopaedic surgery. Anaesthesia. 2003; 58(2): 131-5.
13. Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta- analysis. Br J Anaesth. 2014; 112(6): 991-1004.
14. 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(4): 594-8.
15. Lee C, Song YK, Jeong HM, Park SN. The effects of magnesium sulfate infiltration on perioperative opioid consumption and opioid-induced hyperalgesia in patients undergoing robot-assisted laparoscopic prostatectomy with remifentanil-based anesthesia. Korean J Anesthesiol.2011; 61(3): 244-50.
16. Mentes O, Harlak A, Yigit T, Balkan A, Balkan M, Cosar A, et al. Effect of intraoperative magnesium sulphate infusion on pain relief after laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2008; 52(10): 1353-9.
17. Dabbagh A, Elyasi H, Razavi SS, Fathi M, Rajaei S.
Intravenous magnesium sulfate for post-operative pain in patients undergoing lower limb orthopedic surgery. Acta Anaesthesiol Scand. 2009; 53(8): 1088-91.
18. Ko SH, Lim HR, Kim DC, Han YJ, Choe H, Song HS.
Magnesium sulfate does not reduce postoperative analgesic requirements. Anesthesiology. 2001; 95(3):640-6.
19. Bhatia A, Kashyap L, Pawar DK, Trikha A. Effect of intraoperative magnesium infusion on perioperative analgesia in open cholecystectomy. J Clin Anesth. 2004;
16(4): 262-5.
20. Kiran S, Gupta R, Verma D. Evaluation of a single-dose of intravenous magnesium sulphate for prevention of postoperative pain after inguinal surgery. Indian J Anaesth. 2011; 55(1): 31-5.
21. Koinig H, Wallner T, Marhofer P, Andel H, Horauf K, Mayer N. Magnesium sulfate reduces intra- and postoperative analgesic requirements. Anesth Analg.1998; 87(1): 206-10.
22. Tramer MR, Schneider J, Marti RA, Rifat K. Role of magnesium sulfate in postoperative analgesia. Anesthesiology. 1996; 84(2): 340-7.
23. Ozcan PE, Tugrul S, Senturk NM, Uludag E, Cakar N, Telci L, et al. Role of magnesium sulfate in postoperative pain management for patients undergoing thoracotomy. J Cardiothorac Vasc Anesth. 2007; 21(6): 827-31.
24. Albrecht E, Kirkham KR, Liu SS, Brull R. Peri-operative intravenous administration of magnesium sulphate and postoperative pain: a meta-analysis. Anaesthesia. 2013;68(1): 79-90.
25. Fawcett WJ, Stone JP. Recurarization in the recovery room following the use of magnesium sulphate. Br J Anaesth. 2003; 91(3): 435-8.
26. Na HS, Lee JH, Hwang JY, Ryu JH, Han SH, Jeon YT, et al. Effects of magnesium sulphate on intraoperative neuromuscular blocking agent requirements and postoperative analgesia in children with cerebral palsy. Br J Anaesth. 2010; 104(3): 344-50.
Files
IssueVol 3 No 1-2 (2016) QRcode
SectionOriginal Article(s)
Keywords
Infusions Intravenous Magnesium sulfate Orthognathic surgery Pain Post-operative Pain management
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Eftekharian HR, Hosseini SAA, Heydari ST. The Effect of Intravenous Infusion of Magnesium Sulfate During Bimaxillary Orthognathic Surgery on Post-operative Pain: A Clinical Trial. AJS. 2016;3(1-2):7-11.