Abstract：
A growing worldwide focus on opioid-free anaesthesia entails multimodal analgesic strategies involving non-opioids such as magnesium sulphate (MgSO4). Several systematic reviews have concluded there is beneficial analgesic effect of MgSO4 administration but do not take considerable heterogeneity among the studies into consideration. Medical literature published until June 2021 was searched in PubMed/Medline, Embase, Central and Web of Science: The final search yielded a total of 5,672 articles. We included only randomised controlled trials assessing the effect of intravenous MgSO4 on opioid consumption and acute postoperative pain when compared to either placebo or standardized analgesic treatment. The primary aim was to compare the homogeneity of essential variables and confounders. A post-hoc meta-analysis demonstrated a reduction in both postoperative morphine consumption (-6.12 mg) and pain score (-12.32 VAS points) in favour of the MgSO4-groups. Data for meta-analysis was missing from 19 studies (45%) on morphine consumption and 29 studies (69%) for pain score, the majority of which reports no effect for either morphine consumption or pain score. The calculated heterogeneity among the included studies was considerable for both outcomes; I 2=91% for morphine consumption and I 2=96% for pain score. Although we found a per se reduction in opioid consumption and pain score, methodological heterogeneity and clinical shortcomings of pre-, intra-, and post anaesthetic data precludes conclusions on clinical importance of intraoperative intravenous MgSO4. In addition, the reduction is likely less than what can be gained from using standardized analgesic treatment.
摘要：
世界范围内对无阿片类药物麻醉的日益关注需要涉及非阿片类药物如硫酸镁(MgSO4)的多模式镇痛策略。一些系统评价已经得出结论，MgSO4给药具有有益的镇痛作用，但没有考虑研究之间的相当大的异质性。直到2021年6月出版的医学文献在PubMed/Medline中进行了搜索，Embase,Central和WebofScience：最终搜索总共产生了5,672篇文章。我们仅纳入随机对照试验，评估与安慰剂或标准化镇痛治疗相比，静脉MgSO4对阿片类药物消耗和急性术后疼痛的影响。主要目的是比较基本变量和混杂因素的同质性。事后荟萃分析表明，术后吗啡消耗量（-6.12mg）和疼痛评分（-12.32VAS点）均减少，有利于MgSO4组。荟萃分析的数据在19项关于吗啡消耗的研究(45%)和29项关于疼痛评分的研究(69%)中缺失。其中大多数报告对吗啡消耗或疼痛评分没有影响。在两个结果中，纳入研究之间的计算异质性是相当大的；吗啡消耗I2=91％，疼痛评分I2=96％。尽管我们发现阿片类药物的消耗和疼痛评分本身有所减少，前的方法学异质性和临床缺点，intra-,麻醉后的数据排除了关于术中静脉注射MgSO4的临床重要性的结论。此外,这种减少可能小于使用标准化镇痛治疗所能获得的减少。
