Effectiveness and impact of intravenous magnesium sulfate in spinal surgery systematic review and meta-analysis

Zhaoguo Jin^*jianyong zhao

• Department of Anesthesia, First People's Hospital of Linping District, Hangzhou, China

Background:Effective pain management following spinal surgery is crucial for preventing complications related to delayed mobilization. Magnesium sulfate (MgSO₄) has shown promise as an analgesic agent, influencing neurotransmitter modulation and autonomic nervous system regulation. However, studies evaluating its effectiveness and safety in spinal surgery remain inconsistent, necessitating a comprehensive meta-analysis to assess its role.Objective:This study hypothesized that intravenous magnesium sulfate reduces postoperative pain intensity compared to standard therapies in spinal surgery patients. The primary outcome was pain intensity assessed via Visual Analogue Scale (VAS) at 24 hours postoperatively.Methods:The meta-analysis was conducted in accordance with PRISMA guidelines (registration number: PROSPERO CRD42023285163). We performed data extraction and analysis using Review Manager version 5.4. The study population included patients undergoing spinal surgery, with the intervention group receiving intravenous magnesium sulfate at varying dosages or in combination with other agents. The comparison group received either a placebo or alternative treatments. Primary outcomes included pain intensity, opioid consumption, and safety parameters.Results:Ten randomized controlled trials involving 641 patients were included. Magnesium sulfate significantly reduced pain scores at 24 hours (MD −0.18, 95% CI: −0.34 to −0.02, I²=0%) compared to controls, reflecting homogeneous results. Secondary outcomes included reduced opioid consumption (SMD −0.34, 95% CI: −0.70 to −0.03, I²=71%) and muscle relaxant usage (SMD −0.91, 95% CI: −1.93 to −0.10, I²=92%), though the latter showed substantial heterogeneity, likely due to varying surgical techniques and magnesium dosages across studies. Hemodynamic parameters remained comparable between groups.Conclusion:Intravenous magnesium sulfate demonstrated significant benefits in reducing postoperative pain and opioid consumption, while also improving verbal response and orientation. These findings suggest that magnesium sulfate may serve as a valuable adjunct in the perioperative management of spinal surgery patients. Further research is required to confirm these results and establish optimal dosing protocols.