Lysakowski Christopher, Dumont Lionel, Czarnetzki Christoph, Tramèr Martin R
Division of Anesthesiology, Department Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland.
Anesth Analg. 2007 Jun;104(6):1532-9, table of contents. doi: 10.1213/01.ane.0000261250.59984.cd.
Randomized trials have reached different conclusions as to whether magnesium is a useful adjuvant to postoperative analgesia.
We performed a comprehensive search (electronic databases, bibliographies, all languages, to 4.2006) for randomized comparisons of magnesium and placebo in the surgical setting. Information on postoperative pain intensity and analgesic requirements was extracted from the trials and compared qualitatively. Dichotomous data on adverse effects were combined using classic methods of meta-analysis.
Fourteen randomized trials (778 patients, 404 received magnesium) tested magnesium laevulinate, gluconate or sulfate. With magnesium, postoperative pain intensity was significantly decreased in four (29%) trials, was no different from placebo in seven (50%), and was increased in one (7%); two trials (14%) did not report on pain intensity. With magnesium, postoperative analgesic requirements were significantly reduced in eight (57%) trials, were no different from placebo in five (36%), and were increased in one (7%). Magnesium-treated patients had less postoperative shivering (relative risk 0.38, 95% confidence interval 0.17-0.88, number-needed-to-treat 14). Seven trials reported on magnesium serum levels. In all, serum levels were increased in patients who received magnesium; in six, serum levels were decreased in those who received placebo.
These trials do not provide convincing evidence that perioperative magnesium may have favorable effects on postoperative pain intensity and analgesic requirements. Perioperative magnesium supplementation prevents postoperative hypomagnesemia and decreases the incidence of postoperative shivering. It may be worthwhile to further study the role of magnesium as a supplement to postoperative analgesia, since this relatively harmless molecule is inexpensive, and the biological basis for its potential antinociceptive effect is promising.
关于镁是否是术后镇痛的有效辅助药物，随机试验得出了不同结论。
我们进行了全面检索（电子数据库、参考文献，所有语言，截至2006年4月），以查找手术环境中镁与安慰剂的随机对照研究。从试验中提取术后疼痛强度和镇痛需求的信息并进行定性比较。使用经典的荟萃分析方法合并不良反应的二分数据。
十四项随机试验（778例患者，404例接受镁治疗）测试了乙酰丙酸镁、葡萄糖酸镁或硫酸镁。使用镁时，四项（29%）试验中术后疼痛强度显著降低，七项（50%）试验中与安慰剂无差异，一项（7%）试验中疼痛强度增加；两项试验（14%）未报告疼痛强度。使用镁时，八项（57%）试验中术后镇痛需求显著降低，五项（36%）试验中与安慰剂无差异，一项（7%）试验中需求增加。接受镁治疗的患者术后寒战较少（相对危险度0.38，95%置信区间0.17 - 0.88，需治疗人数14）。七项试验报告了血清镁水平。总体而言，接受镁治疗的患者血清水平升高；六项试验中，接受安慰剂的患者血清水平降低。
这些试验没有提供令人信服的证据表明围手术期镁对术后疼痛强度和镇痛需求可能有有利影响。围手术期补充镁可预防术后低镁血症并降低术后寒战的发生率。进一步研究镁作为术后镇痛补充剂的作用可能是值得的，因为这种相对无害的分子价格低廉，且其潜在抗伤害感受作用的生物学基础很有前景。
