Azimi Amirali, Tabatabaei Fatemeh-Sadat, Azimi Amirfarbod, Mazloom Hamid, Foruzanfar Mohammad Mehdi, Mahdavi Nastaran Sadat
Department of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Emergency Department, Shohadaye Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Arch Acad Emerg Med. 2023 Aug 21;11(1):e58. doi: 10.22037/aaem.v11i1.2058. eCollection 2023.
There has been growing interest in the potential role of adjunctive magnesium sulfate in improving pain management. This systematic review and meta-analysis aimed to assess the effect of intra-operative adjunctive magnesium sulfate on pain management and opioid consumption in total knee arthroplasty (TKA).
A comprehensive search was conducted in Medline, Embase, Scopus, Web of Science, and Cochrane Library databases, covering studies up to April 2023. The extracted data included pain management outcomes, opioid consumption, and adverse effects from the selected studies. Standardized mean differences (SMDs) were calculated for continuous outcomes, while risk ratios (RRs) were calculated for dichotomous outcomes. Meta-analysis was conducted employing random-effects models in STATA 17.
In this meta-analysis of 8 randomized controlled trials involving 536 patients, adjunctive magnesium sulfate in TKA was found to significantly reduce opioid consumption during the first 24 hours after operation (SMD: -1.88, 95% confidence interval (CI): [-3.66 to -0.10]; p = 0.038). It also resulted in lower pain scores at rest 24 hours after surgery (SMD: -1.53, 95% CI: [-2.70 to -0.37]; p = 0.010). There were no significant differences in time to first rescue analgesic and adverse effects between the groups. The included studies were assessed to have low to high levels of risk of bias.
This study presents evidence at low to moderate levels supporting the use of intra-operative adjunctive magnesium sulfate in TKA for improved pain management and reduced opioid consumption. However, further research is needed to address the heterogeneity and to explore optimal dosing regimens and routes of administration to maximize the benefits of magnesium sulfate in TKA.
辅助使用硫酸镁在改善疼痛管理方面的潜在作用已引起越来越多的关注。本系统评价和荟萃分析旨在评估术中辅助使用硫酸镁对全膝关节置换术（TKA）疼痛管理和阿片类药物消耗的影响。
在Medline、Embase、Scopus、Web of Science和Cochrane图书馆数据库中进行了全面检索，涵盖截至2023年4月的研究。从所选研究中提取的数据包括疼痛管理结果、阿片类药物消耗和不良反应。连续结果计算标准化均值差（SMD），二分结果计算风险比（RR）。使用STATA 17中的随机效应模型进行荟萃分析。
在这项对8项随机对照试验（涉及536名患者）的荟萃分析中，发现TKA术中辅助使用硫酸镁可显著减少术后24小时内的阿片类药物消耗（SMD：-1.88，95%置信区间（CI）：[-3.66至-0.10]；p = 0.038）。它还导致术后24小时静息时疼痛评分更低（SMD：-1.53，95%CI：[-2.70至-0.37]；p = 0.010）。两组在首次使用急救镇痛药的时间和不良反应方面无显著差异。纳入的研究被评估为具有低到高的偏倚风险水平。
本研究提供了低到中等水平的证据，支持在TKA术中使用辅助硫酸镁以改善疼痛管理和减少阿片类药物消耗。然而，需要进一步研究以解决异质性问题，并探索最佳给药方案和给药途径，以最大限度地发挥硫酸镁在TKA中的益处。
