Zhang Yuanhui, Huang Yan, Li Jun
Department of Anesthesia, The First People's Hospital of Xianyang, Shaanxi, Xianyang, 712000, PR China.
Department of Anesthesiology, The First People's Hospital of Jiangxia District, Wuhan, Hubei, 712000, PR China.
BMC Pharmacol Toxicol. 2025 May 6;26(1):96. doi: 10.1186/s40360-025-00933-z.
Today, the number of cesarean section has drastically increased. Newer scientific reports have shown Magnesium sulfate (MgSO4) to have favorable outcomes for anesthesia. In this analysis, we aimed to systematically compare the adverse drug events observed with intrathecal MgSO4 as an adjuvant to bupivacaine for spinal anesthesia in patients undergoing elective cesarean section.
MEDLINE, EMBASE, Web of Science, Google scholar, http://www.
gov , and the Cochrane database were searched for relevant publications comparing the adverse drug events observed with intrathecal MgSO4 as an adjuvant to bupivacaine for spinal anesthesia in patients undergoing elective cesarean section. The RevMan software version 5.4 was used to analyze data in this analysis. Risk ratios (RR) with 95% confidence intervals (CIs) were used to represent analysis for the dichotomous data whereas weighted mean difference (WMD) with 95% CI was used to represent results using continuous data. Heterogeneity was assessed by the Q statistic and the I2 statistic tests.
Eleven studies with a total number of 895 participants were included in this analysis whereby 466 patients were assigned to intrathecal MgSO4 and 429 participants were assigned to a control group. The main results of this analysis show that intrathecal MgSO4 as an adjuvant to bupivacaine was associated with a significantly lower risk of shivering (RR: 0.63, 95% CI: 0.48 - 0.83; P = 0.001). In addition, the risks for hypotension (RR: 1.11, 95% CI: 0.86 - 1.44; P = 0.40), nausea and vomiting (RR: 1.08, 95% CI: 0.76 - 1.54; P = 0.65), pruritus (RR: 0.77, 95% CI: 0.51 - 1.17; P = 0.22), and bradycardia (RR: 4.45, 95% CI: 0.97 - 20.36; P = 0.05) were not significantly increased. The sensory (WMD: 23.15, 95% CI: 7.83 - 38.48; P = 0.003), and motor block duration (WMD: 24.29, 95% CI: 16.36 - 32.23; P = 0.00001) and the duration of spinal anesthesia (WMD: 29.24, 95% CI: 13.61 - 44.87; P = 0.0002) were significantly in favor of MgSO4.
Intrathecal MgSO4 as an adjuvant to bupivacaine was associated with a significantly lower risk of shivering without causing any increase in other adverse drug events in patients undergoing elective cesarean section. Efficacy outcomes were also appreciated. Larger studies should be able to confirm this hypothesis.
如今，剖宫产的数量急剧增加。最新的科学报告显示硫酸镁（MgSO4）在麻醉方面有良好效果。在本分析中，我们旨在系统比较在择期剖宫产患者中，鞘内注射MgSO4作为布比卡因脊髓麻醉辅助剂时观察到的药物不良事件。
检索MEDLINE、EMBASE、科学网、谷歌学术、http://www.CLINICALTRIALS.gov以及Cochrane数据库，查找比较在择期剖宫产患者中鞘内注射MgSO4作为布比卡因脊髓麻醉辅助剂时观察到的药物不良事件的相关出版物。本分析使用RevMan软件5.4版来分析数据。风险比（RR）及95%置信区间（CI）用于二分数据的分析，而加权均数差（WMD）及95%CI用于连续数据结果的表示。通过Q统计量和I2统计量检验评估异质性。
本分析纳入了11项研究，共895名参与者，其中466例患者被分配至鞘内注射MgSO4组，429名参与者被分配至对照组。本分析的主要结果表明，鞘内注射MgSO4作为布比卡因的辅助剂与寒战风险显著降低相关（RR：0.63，95%CI：0.48 - 0.83；P = 0.001）。此外，低血压（RR：1.11，95%CI：0.86 - 1.44；P = 0.40）、恶心和呕吐（RR：1.08，95%CI：0.76 - 1.54；P = 0.65）、瘙痒（RR：0.77，9�%CI：0.51 - 1.17；P = 0.22）和心动过缓（RR：4.45，95%CI：0.97 - 20.36；P = 0.05）的风险没有显著增加。感觉（WMD：23.15，95%CI：7.83 - 38.48；P = 0.003）、运动阻滞持续时间（WMD：24.29，95%CI：16.36 - 32.23；P = 0.00001）和脊髓麻醉持续时间（WMD：29.24，95%CI：13.61 - 44.87；P = 0.0002）明显有利于MgSO4。
在择期剖宫产患者中，鞘内注射MgSO4作为布比卡因的辅助剂与寒战风险显著降低相关，且不会导致其他药物不良事件增加。疗效结果也得到了认可。更大规模的研究应该能够证实这一假设。
