静脉注射硫酸镁在骨科手术术后镇痛中的应用：随机对照试验的系统评价

The use of intravenous magnesium sulfate on postoperative analgesia in orthopedic surgery: A systematic review of randomized controlled trials.

作者信息

Peng Yu-Ning, Sung Fung-Chang, Huang Mei-Li, Lin Cheng-Li, Kao Chia-Hung

机构信息

Department of Medicine.

Department of Internal Medicine, College of Medicine, China Medical University.

出版信息

Medicine (Baltimore). 2018 Dec;97(50):e13583. doi: 10.1097/MD.0000000000013583.

DOI:10.1097/MD.0000000000013583

PMID:30558026

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6319973/

Abstract

INTRODUCTION

The aim of this systematic review is to investigate the effects of perioperative intravenous administration of MgSO4 on postoperative pain, analgesic consumption and adverse effects in patients undergoing orthopedic surgery.

METHODS

Two investigators independently searched for articles on randomized controlled trials (RCTs) from 1998 to 2016 in Pubmed, Web of science and Google scholar. We evaluated clinical outcomes, comparing postoperative pain scores, cumulative analgesic consumption, time to first analgesia, and adverse effects between orthopedic surgery patients with and without the administration of MgSO4.

RESULTS

After screening 2350 articles, 11 RCTs (with a total sample size of 535 subjects) were included in this systematic review. Perioperative intravenous administered MgSO4 could reduce postoperative pain intensity compared with control in 6 trials (55%), but without significant difference in 5 trials (45%). With MgSO4 treatments, postoperative analgesic consumption was significantly reduced in 8 trials (73%), and without significant difference in 2 trials (18%). Two trials evaluated the time to first request of analgesic after surgery and showed prolong of 2.3 hours and 93 minutes respectively. MgSO4 group had less postoperative nausea (relative risk [RR] = 0.32, 95% confidence interval [CI] = 0.12-0.82, number needed to harm [NNH] = 8.8), vomiting (RR = 0.38, 95% CI = 0.15-0.92, NNH = 9.7), and shivering (RR = 0.31, 95% CI = 0.11-0.88, NNH = 5.2).

CONCLUSION

Perioperative intravenous administration of MgSO4 in orthopedic surgery could reduce postoperative analgesic consumption and adverse effects such as vomiting, nausea, and shivering. These trials do not provide convincing evidence of beneficial effects on postoperative pain intensity and the time to first analgesic request. More trials should be conducted for the roles of MgSO4 in pain management for orthopedic surgery. However, intravenous MgSO4 administration should be considered as a strategy to relieve postoperative pain in orthopedic surgery patients.

摘要

引言

本系统评价的目的是研究围手术期静脉注射硫酸镁对骨科手术患者术后疼痛、镇痛药物用量及不良反应的影响。

方法

两名研究者独立在Pubmed、科学网和谷歌学术上检索1998年至2016年的随机对照试验（RCT）相关文章。我们评估了临床结局，比较了接受和未接受硫酸镁治疗的骨科手术患者的术后疼痛评分、累积镇痛药物用量、首次镇痛时间及不良反应。

结果

在筛选了2350篇文章后，本系统评价纳入了11项RCT（总样本量为535名受试者）。围手术期静脉注射硫酸镁在6项试验（55%）中与对照组相比可降低术后疼痛强度，但在5项试验（45%）中无显著差异。使用硫酸镁治疗时，8项试验（73%）中术后镇痛药物用量显著减少，2项试验（18%）中无显著差异。两项试验评估了术后首次要求镇痛的时间，分别显示延长了2.3小时和93分钟。硫酸镁组术后恶心（相对危险度[RR]=0.32，95%置信区间[CI]=0.12 - 0.82，伤害所需人数[NNH]=8.8）、呕吐（RR=0.38，95%CI=0.15 - 0.92，NNH=9.7）及寒战（RR=0.31，95%CI=0.11 - 0.88，NNH=5.2）较少。