Effect of Magnesium Sulfate with Ketamine Infusions on Intraoperative and Postoperative Analgesia in Cancer Breast Surgeries: a Randomized Double-blind Trial

Overview

Journal Braz J Anesthesiol

Specialty Anesthesiology

Date 2021 Aug 1

PMID 34332956

Citations 3

Authors

Mohamed Elsayed Hassan

Essam Mahran

Affiliations

Soon will be listed here.

Abstract

Background: Opioids are the cornerstone in managing postoperative pain; however, they have many side effects. Ketamine and Magnesium (Mg) are NMDA receptor antagonists used as adjuvant analgesics to decrease postoperative opioid consumption.

Objective: We assumed that adding Mg to ketamine infusion can improve the intraoperative and postoperative analgesic efficacy of ketamine infusion alone in cancer breast surgeries.

Methods: Ninety patients aged between 18 and 65 years and undergoing elective cancer breast surgery were included in this prospective randomized, double-blind study. Group K received ketamine 0.5.ßmg.kg bolus then 0.12.ßmg.kg.h infusion for the first 24.ßhours postoperatively. Group KM: received ketamine 0.5.ßmg.kg and Mg sulfate 50.ßmg.kg, then ketamine 0.12.ßmg.kg.h and Mg sulfate 8.ßmg.kg.h infusions for the first 24.ßhours postoperative. The primary outcome was the morphine consumption in the first 24.ßhours postoperative, while the secondary outcomes were: intraoperative fentanyl consumption, NRS, side effects, and chronic postoperative pain.

Results: Group KM had less postoperative opioid consumption (14.12.ß...ß5.11.ßmg) than Group K (19.43.ß...ß6.8.ßmg). Also, Group KM had less intraoperative fentanyl consumption. Both groups were similar in postoperative NRS scores, the incidence of side effects related to opioids, and chronic neuropathic pain.

Conclusion: Adding Mg to ketamine infusion can safely improve intraoperative and postoperative analgesia with opioid-sparing effect in cancer breast surgery.

Citing Articles

Use of Ketamine in Patients with Multifactorial Neuropathic Pain: A Systematic Review and Meta-Analysis.

Bruna-Mejias A, Baeza V, Gamboa J, Baez Flores B, San Martin J, Astorga C Pharmaceuticals (Basel). 2024; 17(9).

PMID: 39338327 PMC: 11435086. DOI: 10.3390/ph17091165.

Comment on "Comment on: Effect of magnesium sulfate with ketamine infusions on intraoperative and postoperative analgesia in cancer breast surgeries: a randomized double-blind trial".

Hassan M, Mahran E Braz J Anesthesiol. 2021; 73(4):523.

PMID: 34921903 PMC: 10362451. DOI: 10.1016/j.bjane.2021.11.011.

Comment on: Effect of magnesium sulfate with ketamine infusions on intraoperative and postoperative analgesia in cancer breast surgeries: a randomized double-blind trial.

Magoon R, Mahajan S Braz J Anesthesiol. 2021; 73(3):366.

PMID: 34848311 PMC: 10240224. DOI: 10.1016/j.bjane.2021.11.005.

References

Gan T . Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017; 10:2287-2298. PMC: 5626380. DOI: 10.2147/JPR.S144066. View

Jendoubi A, Naceur I, Bouzouita A, Trifa M, Ghedira S, Chebil M . A comparison between intravenous lidocaine and ketamine on acute and chronic pain after open nephrectomy: A prospective, double-blind, randomized, placebo-controlled study. Saudi J Anaesth. 2017; 11(2):177-184. PMC: 5389236. DOI: 10.4103/1658-354X.203027. View

Tramer M, Schneider J, Marti R, Rifat K . Role of magnesium sulfate in postoperative analgesia. Anesthesiology. 1996; 84(2):340-7. DOI: 10.1097/00000542-199602000-00011. View

OFlaherty J, Lin C . Does ketamine or magnesium affect posttonsillectomy pain in children?. Paediatr Anaesth. 2003; 13(5):413-21. DOI: 10.1046/j.1460-9592.2003.01049.x. View

McCartney C, Sinha A, Katz J . A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventive analgesia. Anesth Analg. 2004; 98(5):1385-400, table of contents. DOI: 10.1213/01.ane.0000108501.57073.38. View

Zakine J, Samarcq D, Lorne E, Moubarak M, Montravers P, Beloucif S . Postoperative ketamine administration decreases morphine consumption in major abdominal surgery: a prospective, randomized, double-blind, controlled study. Anesth Analg. 2008; 106(6):1856-61. DOI: 10.1213/ane.0b013e3181732776. View

Remerand F, Le Tendre C, Baud A, Couvret C, Pourrat X, Favard L . The early and delayed analgesic effects of ketamine after total hip arthroplasty: a prospective, randomized, controlled, double-blind study. Anesth Analg. 2009; 109(6):1963-71. DOI: 10.1213/ANE.0b013e3181bdc8a0. View

Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J . Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005; 114(1-2):29-36. DOI: 10.1016/j.pain.2004.12.010. View

Martinez V, Beloeil H, Marret E, Fletcher D, Ravaud P, Trinquart L . Non-opioid analgesics in adults after major surgery: systematic review with network meta-analysis of randomized trials. Br J Anaesth. 2017; 118(1):22-31. DOI: 10.1093/bja/aew391. View

10.

Petrenko A, Yamakura T, Baba H, Shimoji K . The role of N-methyl-D-aspartate (NMDA) receptors in pain: a review. Anesth Analg. 2003; 97(4):1108-1116. DOI: 10.1213/01.ANE.0000081061.12235.55. View

11.

Liu H, Hollmann M, Liu W, Hoenemann C, Durieux M . Modulation of NMDA receptor function by ketamine and magnesium: Part I. Anesth Analg. 2001; 92(5):1173-81. DOI: 10.1097/00000539-200105000-00019. View

12.

Akhavanakbari G, Mohamadian A, Entezariasl M . Evaluation the effects of adding ketamine to morphine in intravenous patient-controlled analgesia after orthopedic surgery. Perspect Clin Res. 2014; 5(2):85-7. PMC: 3980550. DOI: 10.4103/2229-3485.128028. View

13.

Jabbour H, Naccache N, Jawish R, Abou Zeid H, Jabbour K, Rabbaa-Khabbaz L . Ketamine and magnesium association reduces morphine consumption after scoliosis surgery: prospective randomised double-blind study. Acta Anaesthesiol Scand. 2014; 58(5):572-9. DOI: 10.1111/aas.12304. View

14.

Tramer M, Glynn C . An evaluation of a single dose of magnesium to supplement analgesia after ambulatory surgery: randomized controlled trial. Anesth Analg. 2007; 104(6):1374-9, table of contents. DOI: 10.1213/01.ane.0000263416.14948.dc. View

15.

El Mourad M, Arafa S . Effect of intravenous versus intraperitoneal magnesium sulfate on hemodynamic parameters and postoperative analgesia during laparoscopic sleeve gastrectomy-A prospective randomized study. J Anaesthesiol Clin Pharmacol. 2019; 35(2):242-247. PMC: 6598561. DOI: 10.4103/joacp.JOACP_208_18. View

16.

Viscusi E . Patient-controlled drug delivery for acute postoperative pain management: a review of current and emerging technologies. Reg Anesth Pain Med. 2008; 33(2):146-58. DOI: 10.1016/j.rapm.2007.11.005. View

17.

Mendonca F, Pellizzaro D, Grossi B, Calvano L, de Carvalho L, Sposito A . Synergistic effect of the association between lidocaine and magnesium sulfate on peri-operative pain after mastectomy: A randomised, double-blind trial. Eur J Anaesthesiol. 2020; 37(3):224-234. DOI: 10.1097/EJA.0000000000001153. View

18.

Ramsay M, Savege T, Simpson B, Goodwin R . Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974; 2(5920):656-9. PMC: 1613102. DOI: 10.1136/bmj.2.5920.656. View

19.

Helander E, Menard B, Harmon C, Homra B, Allain A, Bordelon G . Multimodal Analgesia, Current Concepts, and Acute Pain Considerations. Curr Pain Headache Rep. 2017; 21(1):3. DOI: 10.1007/s11916-017-0607-y. View

20.

Kim S, Kim S, Ok S, Park S, Kim M, Lee S . Opioid sparing effect of low dose ketamine in patients with intravenous patient-controlled analgesia using fentanyl after lumbar spinal fusion surgery. Korean J Anesthesiol. 2013; 64(6):524-8. PMC: 3695250. DOI: 10.4097/kjae.2013.64.6.524. View