Kim Richard K, Kim James W, Angelotti Timothy, Esquivel Micaela, Tsui Ban C, Hwang Joo H
From the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California.
Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California.
Anesth Analg. 2025 Jan 1;140(1):54-61. doi: 10.1213/ANE.0000000000006990. Epub 2024 Jun 7.
Postoperative esophageal pain occurs in 67% of patients after peroral endoscopic esophageal myotomy (POEM). Magnesium can act as a smooth muscle relaxant. This study investigated whether intraoperative magnesium can reduce postoperative esophageal pain in patients undergoing POEM.
In this double-blind, placebo-controlled trial, 92 patients were randomized to receive either magnesium sulfate as a 50 mg.kg -1 (total body weight) bolus followed by an infusion at 25 mg.kg -1 .hr -1 , or 0.9% saline. Intraoperative analgesia was standardized in all patients. The primary outcome was the score from a validated, modified Esophageal Symptoms Questionnaire (ESQ) in the postanesthesia care unit (PACU). Pain scores, opioid requirements, and questionnaire scores were collected through postoperative day 1.
ESQ scores were significantly lower in the magnesium group in the PACU (median [25th-75th], 24 [18-31] vs 35 [28-42]; median difference [95% confidence interval, CI], 10 [6-13]; P < .0001) and on postoperative day 1 (16 [14-23] vs 30 [24-35]; P < .0001). Less opioids were needed in the magnesium group in the PACU (mean ± standard deviation [SD] [99% CI], 4.7 ± 10 [1-9] mg vs 29 ± 21 [21-37] mg; P < .0001) and on postoperative day 1 (1 ± 3.7 [0-2.5] mg vs 13 ± 23 [4-23] mg; P = .0009). Pain scores were lower in the magnesium group in the PACU (0 [0-3] vs 5 [5-7]; P < .0001) and on postoperative day 1 (0 [0-2] vs 4 [3-5]; P < .0001).
Patients undergoing POEM randomized to receive intraoperative magnesium had sustained reductions in esophageal discomfort severity and opioid requirements 24 hours after surgery.
经口内镜下食管肌切开术（POEM）后，67%的患者会出现术后食管疼痛。镁可作为平滑肌松弛剂。本研究调查了术中使用镁能否减轻接受POEM治疗患者的术后食管疼痛。
在这项双盲、安慰剂对照试验中，92例患者被随机分为两组，一组接受50mg·kg-1（总体重）硫酸镁推注，随后以25mg·kg-1·h-1的速度输注；另一组接受0.9%生理盐水。所有患者术中镇痛均标准化。主要结局是麻醉后护理单元（PACU）中经过验证的改良食管症状问卷（ESQ）评分。术后第1天收集疼痛评分、阿片类药物需求量和问卷评分。
PACU中镁组的ESQ评分显著低于安慰剂组（中位数[第25-75百分位数]，24[18-31]对35[28-42]；中位数差异[95%置信区间，CI]，10[6-13]；P<.0001），术后第1天也是如此（16[14-23]对30[24-35]；P<.0001）。PACU中镁组所需阿片类药物较少（均值±标准差[SD][99%CI]，4.7±10[1-9]mg对29±21[
