Effects of magnesium sulfate on periarticular infiltration analgesia in total knee arthroplasty: a prospective, double-blind, randomized controlled trial. 2023

Chengcheng Zhao, and Liying Wang, and Liyile Chen, and Qiuru Wang, and Pengde Kang
Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China.

BACKGROUND To investigate whether adding magnesium sulfate to a periarticular infiltration analgesia (PIA) cocktail could improve pain control and functional outcomes in patients undergoing total knee arthroplasty (TKA). METHODS Ninety patients were randomly assigned to the magnesium sulfate and control groups, with 45 patients in each group. In the magnesium sulfate group, patients were given a periarticular infusion of a cocktail of analgesics consisting of epinephrine, ropivacaine, magnesium sulfate, and dexamethasone. The control group received no magnesium sulfate. The primary outcomes consisted of visual analogue scale (VAS) pain scores, postoperative morphine hydrochloride consumption for rescue analgesia, and time to first rescue analgesia. Secondary outcomes were postoperative inflammatory biomarkers (IL-6 and CRP), postoperative length of stay, and knee functional recovery (assessed by knee range of motion, quadriceps strength, daily mobilization distance, and time to first straight-leg raising). Tertiary outcomes included the postoperative swelling ratio and complication rates. RESULTS Within 24 h of surgery, patients in the magnesium sulfate group had markedly lower VAS pain scores during motion and at rest. After the addition of magnesium sulfate, the analgesic effect was dramatically prolonged, leading to a reduction in morphine dosage within 24 h and the total morphine dosage postoperatively. Postoperative inflammatory biomarker levels were significantly reduced in the magnesium sulfate group compared with the control. There were no considerable differences between the groups in terms of the postoperative length of stay and knee functional recovery. Both groups had similar postoperative swelling ratios and incidences of complications. CONCLUSIONS The addition of magnesium sulfate to the analgesic cocktail for PIA can prolong postoperative analgesia, decrease the consumption of opioids, and effectively alleviate early postoperative pain after TKA. BACKGROUND Chinese Clinical Trial Registry, ChiCTR2200056549. Registered on 7 February 2022, https://www.chictr.org.cn/showproj.aspx?proj=151489 .

UI MeSH Term Description Entries
D008278 Magnesium Sulfate A small colorless crystal used as an anticonvulsant, a cathartic, and an electrolyte replenisher in the treatment of pre-eclampsia and eclampsia. It causes direct inhibition of action potentials in myometrial muscle cells. Excitation and contraction are uncoupled, which decreases the frequency and force of contractions. (From AMA Drug Evaluations Annual, 1992, p1083) Magnesium Sulfate, Heptahydrate,Heptahydrate Magnesium Sulfate,Sulfate, Magnesium
D009020 Morphine The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. Morphine Sulfate,Duramorph,MS Contin,Morphia,Morphine Chloride,Morphine Sulfate (2:1), Anhydrous,Morphine Sulfate (2:1), Pentahydrate,Oramorph SR,SDZ 202-250,SDZ202-250,Chloride, Morphine,Contin, MS,SDZ 202 250,SDZ 202250,SDZ202 250,SDZ202250,Sulfate, Morphine
D010149 Pain, Postoperative Pain during the period after surgery. Acute Post-operative Pain,Acute Postoperative Pain,Chronic Post-operative Pain,Chronic Post-surgical Pain,Chronic Postoperative Pain,Chronic Postsurgical Pain,Pain, Post-operative,Persistent Postsurgical Pain,Post-operative Pain,Post-operative Pain, Acute,Post-operative Pain, Chronic,Post-surgical Pain,Postoperative Pain, Acute,Postoperative Pain, Chronic,Postsurgical Pain,Postoperative Pain,Acute Post operative Pain,Chronic Post operative Pain,Chronic Post surgical Pain,Chronic Postsurgical Pains,Pain, Acute Post-operative,Pain, Acute Postoperative,Pain, Chronic Post-operative,Pain, Chronic Post-surgical,Pain, Chronic Postoperative,Pain, Chronic Postsurgical,Pain, Persistent Postsurgical,Pain, Post operative,Pain, Post-surgical,Pain, Postsurgical,Post operative Pain,Post operative Pain, Acute,Post operative Pain, Chronic,Post surgical Pain,Post-operative Pains,Post-surgical Pain, Chronic,Postsurgical Pain, Chronic,Postsurgical Pain, Persistent
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000698 Analgesia Methods of PAIN relief that may be used with or in place of ANALGESICS. Analgesias
D000700 Analgesics Compounds capable of relieving pain without the loss of CONSCIOUSNESS. Analgesic,Anodynes,Antinociceptive Agents,Analgesic Agents,Analgesic Drugs,Agents, Analgesic,Agents, Antinociceptive,Drugs, Analgesic
D000701 Analgesics, Opioid Compounds with activity like OPIATE ALKALOIDS, acting at OPIOID RECEPTORS. Properties include induction of ANALGESIA or NARCOSIS. Opioid,Opioid Analgesic,Opioid Analgesics,Opioids,Full Opioid Agonists,Opioid Full Agonists,Opioid Mixed Agonist-Antagonists,Opioid Partial Agonists,Partial Opioid Agonists,Agonist-Antagonists, Opioid Mixed,Agonists, Full Opioid,Agonists, Opioid Full,Agonists, Opioid Partial,Agonists, Partial Opioid,Analgesic, Opioid,Full Agonists, Opioid,Mixed Agonist-Antagonists, Opioid,Opioid Agonists, Full,Opioid Agonists, Partial,Opioid Mixed Agonist Antagonists,Partial Agonists, Opioid
D000779 Anesthetics, Local Drugs that block nerve conduction when applied locally to nerve tissue in appropriate concentrations. They act on any part of the nervous system and on every type of nerve fiber. In contact with a nerve trunk, these anesthetics can cause both sensory and motor paralysis in the innervated area. Their action is completely reversible. (From Gilman AG, et. al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed) Nearly all local anesthetics act by reducing the tendency of voltage-dependent sodium channels to activate. Anesthetics, Conduction-Blocking,Conduction-Blocking Anesthetics,Local Anesthetic,Anesthetics, Topical,Anesthetic, Local,Anesthetics, Conduction Blocking,Conduction Blocking Anesthetics,Local Anesthetics,Topical Anesthetics
D019645 Arthroplasty, Replacement, Knee Replacement of the knee joint. Knee Replacement, Total,Arthroplasties, Knee Replacement,Arthroplasties, Replacement, Knee,Arthroplasty, Knee Replacement,Arthroplasty, Replacement, Partial Knee,Knee Arthroplasty,Knee Arthroplasty, Total,Knee Replacement Arthroplasties,Knee Replacement Arthroplasty,Partial Knee Arthroplasty,Partial Knee Replacement,Replacement Arthroplasties, Knee,Replacement Arthroplasty, Knee,Replacement, Total Knee,Total Knee Replacement,Unicompartmental Knee Arthroplasty,Unicompartmental Knee Replacement,Unicondylar Knee Arthroplasty,Unicondylar Knee Replacement,Arthroplasty, Knee,Arthroplasty, Partial Knee,Arthroplasty, Total Knee,Arthroplasty, Unicompartmental Knee,Arthroplasty, Unicondylar Knee,Knee Arthroplasty, Partial,Knee Arthroplasty, Unicompartmental,Knee Arthroplasty, Unicondylar,Knee Replacement, Partial,Knee Replacement, Unicompartmental,Knee Replacement, Unicondylar,Total Knee Arthroplasty

Related Publications

Chengcheng Zhao, and Liying Wang, and Liyile Chen, and Qiuru Wang, and Pengde Kang
July 2023, The Journal of arthroplasty,
Chengcheng Zhao, and Liying Wang, and Liyile Chen, and Qiuru Wang, and Pengde Kang
December 2020, International orthopaedics,
Chengcheng Zhao, and Liying Wang, and Liyile Chen, and Qiuru Wang, and Pengde Kang
March 2021, Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA,
Chengcheng Zhao, and Liying Wang, and Liyile Chen, and Qiuru Wang, and Pengde Kang
June 2021, International orthopaedics,
Chengcheng Zhao, and Liying Wang, and Liyile Chen, and Qiuru Wang, and Pengde Kang
November 2015, The Journal of arthroplasty,
Chengcheng Zhao, and Liying Wang, and Liyile Chen, and Qiuru Wang, and Pengde Kang
November 2008, Acta anaesthesiologica Scandinavica,
Chengcheng Zhao, and Liying Wang, and Liyile Chen, and Qiuru Wang, and Pengde Kang
January 2011, Singapore medical journal,
Chengcheng Zhao, and Liying Wang, and Liyile Chen, and Qiuru Wang, and Pengde Kang
March 2022, The journal of knee surgery,
Chengcheng Zhao, and Liying Wang, and Liyile Chen, and Qiuru Wang, and Pengde Kang
July 2014, Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA,
Chengcheng Zhao, and Liying Wang, and Liyile Chen, and Qiuru Wang, and Pengde Kang
February 2024, The Journal of arthroplasty,
Copied contents to your clipboard!