Kawakami Hiromasa, Mihara Takahiro, Nakamura Nobuhito, Ka Koui, Goto Takahisa
Department of Anesthesiology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
PLoS One. 2018 Jan 2;13(1):e0190354. doi: 10.1371/journal.pone.0190354. eCollection 2018.
Magnesium has been investigated as an adjuvant for neuraxial anesthesia, but the effect of caudal magnesium on postoperative pain is inconsistent. The aim of this systematic review and meta-analysis was to evaluate the analgesic effect of caudal magnesium.
We searched six databases, including trial registration sites. Randomized clinical trials reporting the effect of caudal magnesium on postoperative pain after general anesthesia were eligible. The risk ratio for use of rescue analgesics after surgery was combined using a random-effects model. We also assessed adverse events. The I2 statistic was used to assess heterogeneity. We assessed risk of bias with Cochrane domains. We controlled type I and II errors due to sparse data and repetitive testing with Trial Sequential Analysis. We assessed the quality of evidence with GRADE.
Four randomized controlled trials (247 patients) evaluated the need for rescue analgesics. In all four trials, 50 mg of magnesium was administered with caudal ropivacaine. The results suggested that the need for rescue analgesia was reduced significantly by caudal magnesium administration (risk ratio 0.45; 95% confidence interval 0.24-0.86). There was considerable heterogeneity as indicated by an I2 value of 62.5%. The Trial Sequential Analysis-adjusted confidence interval was 0.04-5.55, indicating that further trials are required. The quality of evidence was very low. The rate of adverse events was comparable between treatment groups.
Caudal magnesium may reduce the need for rescue analgesia after surgery, but further randomized clinical trials with a low risk of bias and a low risk of random errors are necessary to assess the effect of caudal magnesium on postoperative pain and adverse events.
University Hospital Medical Information Network Clinical Trials Registry UMIN000025344.
镁已被研究作为神经轴索麻醉的辅助药物，但骶管注射镁对术后疼痛的影响并不一致。本系统评价和荟萃分析的目的是评估骶管注射镁的镇痛效果。
我们检索了六个数据库，包括试验注册网站。报告骶管注射镁对全身麻醉后术后疼痛影响的随机临床试验符合纳入标准。术后使用补救镇痛药的风险比采用随机效应模型进行合并。我们还评估了不良事件。I²统计量用于评估异质性。我们采用Cochrane领域评估偏倚风险。我们通过试验序贯分析控制了由于数据稀疏和重复检验导致的I类和II类错误。我们采用GRADE评估证据质量。
四项随机对照试验（247例患者）评估了补救镇痛药的使用需求。在所有四项试验中，均将50mg镁与骶管注射罗哌卡因联合使用。结果表明，骶管注射镁可显著降低补救镇痛的需求（风险比0.45；95%置信区间0.24 - 0.86）。I²值为62.5%，表明存在相当大的异质性。试验序贯分析调整后的置信区间为0.04 - 5.55，表明需要进一步的试验。证据质量非常低。各治疗组之间不良事件发生率相当。
骶管注射镁可能降低术后补救镇痛的需求，但需要进一步开展偏倚风险低和随机误差风险低的随机临床试验，以评估骶管注射镁对术后疼痛和不良事件的影响。
大学医院医学信息网络临床试验注册库UMIN000025344
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