Magnesium as an adjuvant in perioperative analgesia: data from randomised trials and meta-analyses

Introduction : The role of magnesium in perioperative analgesia has been investigated by an increasing number of authors in recent years. The implementation of ERAS (Enhanced Recovery After Surgery) protocols in clinical practice necessitates the search for new co-analgesics (adjuvants) to include in a multimodal analgesic regimen that would reduce or eliminate the use of opioids. Their side effects, combined with the current opioid epidemic, have catalysed efforts to find new models of balanced anaesthesia and analgesia. Methodology : This literature review includes and analyses 38 clinical studies examining the analgesic properties of magnesium sulphate (MgSO 4 ) over the past three decades. It covers 32 randomised controlled trials (RCTs), 5 systematic reviews and meta-analyses of RCTs, and one retrospective cohort study. The search was conducted in databases (PubMed, DeepDyve) using the following keywords: anesthesia, analgesic request, consumption, MgSO 4 , multimodal, opioids, postoperative, pain, recovery, requirements, scores Results : Approximately 90% of the analysed studies demonstrate a positive effect of perioperative magnesium administration on intraoperative anaesthetic and postoperative analgesic requirements, pain scores, quality of recovery, haemodynamic profile, and other measures, without leading to adverse effects or complications at the dosing regimens used. Conclusion : Analysis of the data indicates that intravenous magnesium is a potential analgesic with a favourable safety and cost-effectiveness profile and can play an important role as an adjuvant in perioperative analgesia. However, additional large-scale studies with standardised protocols are needed to determine its optimal dosages, as well as the indications and contraindications for its use in clinical anaesthesia practice.