Department of Anesthesiology, The Affiliated Hospital of Stomatology, Chongqing Medical University.
Department of Anesthesiology, Chongqing University Cancer Hospital/Chongqing Cancer Institute, Chongqing.
Clin J Pain. 2021 Aug 1;37(8):629-637. doi: 10.1097/AJP.0000000000000944.
With the popularization of ultrasound, nerve blocks have been widely implemented in current clinical practice. Although, they have seen limited success due to their shorter duration and suboptimal analgesia. Magnesium sulfate as a local anesthetic adjuvant for peripheral nerve blocks could enhance the effects of local anesthetics. However, previous investigations have not thoroughly investigated the analgesic efficacy of magnesium sulfate as an adjunct to local anesthetics for peripheral nerve blocks. Thus, we attempted to fill the gap in the existing literature by conducting a meta-analysis.
We performed of a quantitative systematic review of randomized controlled trials published between May 30, 2011 and November 1, 2018. Inclusion criteria were: (1) magnesium sulfate used as adjuvant mixed with local anesthetic for nerve blockade, (2) complete articles and published abstracts of randomized controlled trials, (3) English language.
The primary outcome measures were time of onset, total duration of the sensory blockade, and Visual Analog Scale pain scores. The secondary outcomes were postoperative oral and intravenous analgesics consumption and the incidence of nausea and vomiting.
The 21 trials analyzed in this study included 1323 patients. Magnesium sulfate effectively prolonged the total duration of sensory blockade (mean difference [MD]=114.59 min, 95% confidence interval [CI]: 89.31-139.88), reducing Visual Analog Scale pain scores at 6 hours (MD=1.36 points, 95% CI: -2.09 to -0.63) and 12 hours (MD=1.54 points, 95% CI: -2.56 to -0.53) postsurgery. Magnesium sulfate also effectively reduced postoperative analgesic use within 24 hours postsurgery (standard MD=-2.06, 95% CI: -2.67 to -1.35). Furthermore, adjuvant magnesium sulfate significantly reduced the incidence of nausea and vomiting after transversus abdominis plane blockade (odds ratio: 0.39, 95% CI: 0.18-0.81).
Adjuvant magnesium sulfate enhanced the anesthetic effects of local anesthetics and improved postoperative analgesia following the perineural blockade.
随着超声技术的普及，神经阻滞已广泛应用于临床实践。然而，由于其作用持续时间较短，镇痛效果不佳，因此应用受到限制。硫酸镁作为局部麻醉剂的佐剂，可增强局部麻醉剂的效果。然而，之前的研究并未充分探讨硫酸镁作为外周神经阻滞局部麻醉剂佐剂的镇痛效果。因此，我们试图通过荟萃分析填补现有文献中的空白。
我们对 2011 年 5 月 30 日至 2018 年 11 月 1 日期间发表的随机对照试验进行了定量系统评价。纳入标准为：（1）硫酸镁作为佐剂与局部麻醉剂混合用于神经阻滞；（2）完整的文章和随机对照试验的已发表摘要；（3）英语。
主要结局指标为起效时间、感觉阻滞的总持续时间和视觉模拟评分。次要结局指标为术后口服和静脉镇痛药的使用以及恶心呕吐的发生率。
本研究分析的 21 项试验共纳入 1323 例患者。硫酸镁可有效延长感觉阻滞的总持续时间（平均差值[MD]=114.59 分钟，95%置信区间[CI]：89.31-139.88），降低术后 6 小时（MD=1.36 分，95%CI：-2.09 至-0.63）和 12 小时（MD=1.54 分，95%CI：-2.56 至-0.53）的视觉模拟评分。硫酸镁还可有效减少术后 24 小时内的镇痛药物使用（标准 MD=-2.06，95%CI：-2.67 至-1.35）。此外，辅助用硫酸镁可显著降低腹横肌平面阻滞术后恶心呕吐的发生率（比值比：0.39，95%CI：0.18-0.81）。
辅助用硫酸镁增强了局部麻醉剂的麻醉效果，并改善了神经周围阻滞术后的镇痛效果。
