Key result
Caudal magnesium cuts postoperative rescue analgesia needs ~55% vs local anesthetics alone in pediatric surgery.
Why the study?
The effect of caudal magnesium as an adjuvant to local anesthetics on postoperative pain in pediatric surgical patients is inconsistent and uncertain.
Does caudal magnesium added to local anesthetics reduce the need for postoperative rescue analgesia in pediatric surgical patients?
Meta-Analysis (n=247)
Does caudal magnesium added to local anesthetics reduce the need for postoperative rescue analgesia in pediatric surgical patients?
Caudal magnesium added to local anesthetics may reduce the need for postoperative rescue analgesia in pediatric patients, but current evidence is of very low quality and requires confirmation.
May reduce rescue analgesia needs in pediatric caudal anesthesia; leaves open confirmation pending larger, low-bias RCTs.
BACKGROUND: Magnesium has been investigated as an adjuvant for neuraxial anesthesia, but the effect of caudal magnesium on postoperative pain is inconsistent. The aim of this systematic review and meta-analysis was to evaluate the analgesic effect of caudal magnesium. METHODS: We searched six databases, including trial registration sites. Randomized clinical trials reporting the effect of caudal magnesium on postoperative pain after general anesthesia were eligible. The risk ratio for use of rescue analgesics after surgery was combined using a random-effects model. We also assessed adverse events. The I2 statistic was used to assess heterogeneity. We assessed risk of bias with Cochrane domains. We controlled type I and II errors due to sparse data and repetitive testing with Trial Sequential Analysis. We assessed the quality of evidence with GRADE. RESULTS: Four randomized controlled trials (247 patients) evaluated the need for rescue analgesics. In all four trials, 50 mg of magnesium was administered with caudal ropivacaine. The results suggested that the need for rescue analgesia was reduced significantly by caudal magnesium administration (risk ratio 0.45; 95% confidence interval 0.24-0.86). There was considerable heterogeneity as indicated by an I2 value of 62.5%. The Trial Sequential Analysis-adjusted confidence interval was 0.04-5.55, indicating that further trials are required. The quality of evidence was very low. The rate of adverse events was comparable between treatment groups. CONCLUSION: Caudal magnesium may reduce the need for rescue analgesia after surgery, but further randomized clinical trials with a low risk of bias and a low risk of random errors are necessary to assess the effect of caudal magnesium on postoperative pain and adverse events. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry UMIN000025344.
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Kawakami et al. (2018) conducted a meta-analysis in Postoperative pain in pediatric surgical patients (n=247). Caudal magnesium added to local anesthetics vs. Local anesthetics alone (placebo/no magnesium) was evaluated on Need for rescue analgesia (acetaminophen) after surgery (RR 0.45, 95% CI 0.24-0.86). Caudal magnesium added to local anesthetics reduced the need for postoperative rescue analgesia in pediatric surgical patients (RR 0.45), although Trial Sequential Analysis indicated further trials are required.
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