Comparison of Two Different Doses of Magnesium Sulfate on the Prevention of Pain During Etomidate Injection

Document Type : Original Article(s)

Authors

1 Professor, Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Medical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

10.48305/jims.v43.i837.1401

Abstract

Background: Etomidate is a relatively safe drug that is used in short-term anesthesia. Despite the many benefits, patients complain of pain during injection. Previous studies have recommended a dose of 620 mg of magnesium sulfate to reduce pain in patients. In this study, we tried to investigate different doses of magnesium sulfate for the prevention of pain caused by etomidate injection and its complications.
Methods: In this triple-blind clinical trial, 90 patients aged 18 to 65 years, who were candidates for surgery under general anesthesia, after meeting the inclusion and exclusion criteria, were randomly divided into three groups (magnesium sulfate 50% 750 mg, magnesium sulfate 50% 1 gram, and normal saline as control). Magnesium sulfate was administered prior to etomidate injection. Patients were monitored for background characteristics and vital signs before surgery.
Findings: The mean age of the patients was 41.73 ± 17.22 years, and 60.75% of the patients were male. The diastolic blood pressure and heart rate before etomidate injection were higher in the 50% magnesium sulfate group with a one-gram dose (P < 0.05). The duration of surgery, anesthesia and extubation in the group receiving 750 mg of 50% magnesium sulfate was longer than that in the 1 gram dose group (P < 0.05). The intensity of initial pain, as well as pain after 10 minutes and the change in pain after 10 minutes compared to the initial pain, did not differ among the three groups (P > 0.05). Patients with a higher dose had an increase in diastolic blood pressure but a decrease in mean blood pressure in the first 10 minutes (P < 0.05).
Conclusion: Although the two different doses of magnesium sulfate did not show significant analgesic effects compared to each other, the use of a 1-gram dose was more successful than 750 mg in controlling mild to moderate pain.

Highlights

Azim Honarmand: Google Scholar, PubMed

Keywords

Main Subjects

References

  1. Nazemroaya B, Aghadavodi O, Honarmand A, Ahmadian S. A comparative study of valsalva maneuver, lidocaine, and valsalva maneuvers with administration of lidocaine to reduce the pain associated with administration of etomidate during general Anesthesia. Anesth Pain Med 2021; 11(3): e113408.
  2. Doenicke AW, Roizen MF, Hoernecke R, Lorenz W, Ostwald P. Solvent for etomidate may cause pain and adverse effects. Br J Anaesth 1999; 83(3): 464-6.
  3. Nazemroaya B, Honarmand A, Bab Hadi Ashar M. Effects of adding dexmedetomidine to ketamine on heart rate and blood pressure changs in psychiatric patients undergoing electroconvulsive therapy [in Persian]. Koomesh 2020; 22 (2) :311-316
  4. Cavalcanti IL, de Lima FLT, da Silva MJS, da Cruz Filho RA, Braga ELC, Verçosa N. Use Profile of Magnesium Sulfate in Anesthesia in Brazil. Front Pharmacol 2019; 10: 429.
  5. Nazemroaya B, Jabalameli M, Kamali A. Assessing the effects of dexmedetomidine and labetalol on changes in heart rate and blood pressure after laryngoscopy compared to a control group. J Cell Mol Anesth 2020; 5(2): 79-83.
  6. Deepa T, Chandran D. Effect of addition of intrathecal magnesium sulphate to 0.5% hyperbaric bupivacaine and 0.5% isobaric levobupivacaine on duration of analgesia in parturients undergoing elective caesarean section: A prospective randomised study. J Anaesthesiol Clin Pharmacol 2021; 37(4): 633-8.
  7. Rashid MR, Najeeb R, Mushtaq S, Habib R. Comparative evaluation of midazolam, dexmedetomidine, and propofol as Intensive Care Unit sedatives in postoperative electively ventilated eclamptic patients. J Anaesthesiol Clin Pharmacol 2017; 33(3): 331-6.
  8. Avci Y, Rajarathinam M, Kalsekar N, Tawfic Q, Krause S, Nguyen D, et al. Unravelling the analgesic effects of perioperative magnesium in general abdominal surgery: a systematic review and meta-analysis of randomized controlled trials. Braz J Anesthesiol 2024; 74(4): 844524.
  9. Albrecht E, Kirkham KR, Liu SS, Brull R. Peri‐operative intravenous administration of magnesium sulphate and postoperative pain: a meta‐analysis. Anaesthesia 2013; 68(1): 79-90.
  10. Kido K, Katagiri N, Kawana H, Sugino S, Konno D, Suzuki J, et al. Effects of magnesium sulfate administration in attenuating chronic postsurgical pain in rats. Biochem Biophys Res Commun 2021; 534: 395-400.
  11. Ma S, Zhang Y, Li Q. Magnesium sulfate reduces postoperative pain in women with cesarean section: A meta-analysis of randomized controlled trials. Pain Pract 2022; 22(1): 8-18.
  12. Albrecht E, Kirkham KR, Liu SS, Brull R. Peri-operative intravenous administration of magnesium sulphate and postoperative pain: a meta-analysis. Anaesthesia 2013; 68(1): 79-90.
  13. Honarmand A, Safavi MR. Magnesium sulphate pretreatment to alleviate pain on propofol injection: A comparison with ketamine or lidocaine. Acute Pain 2008; 10(1): 23-9.
  14. Galgon RE, Strube P, Heier J, Groth J, Wang S, Schroeder KM. Magnesium sulfate with lidocaine for preventing propofol injection pain: a randomized, double-blind, placebo-controlled trial. J Anesth 2015; 29(2): 206-11.
  15. Chen C, Tao R. The impact of magnesium sulfate on pain control after laparoscopic cholecystectomy: a meta-analysis of randomized controlled studies. Surg Laparosc Endosc Percutan Tech 2018; 28(6): 349-53.
  16. Ko SH, Lim HR, Kim DC, Han YJ, Choe H, Song HS. Magnesium sulfate does not reduce postoperative analgesic requirements. Anesthesiology 2001; 95(3): 640-6.
  17. Ryu JH, Kang MH, Park KS, Do SH. Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia. Br J Anaesth 2008; 100(3): 397-403.
  18. Picard P, Tramèr MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000; 90(4): 963-9.
  19. Owen H, Spence A. Etomidate. Oxford, UK: Oxford University Press; 1984. p. 555-7.
  20. Woolf CJ, Thompson SWN. The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain 1991; 44(3): 293-9.
  21. Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain 2009; 10(9): 895-926.
  22. Dingledine R, Borges K, Bowie D, Traynelis SF. The glutamate receptor ion channels. Pharmacol Rev 1999; 51(1): 7-61.
  23. Paoletti P, Neyton J. NMDA receptor subunits: function and pharmacology. Curr Opin Pharmacol 2007; 7(1): 39-47.
  24. Mayer ML, Westbrook GL, Guthrie PB. Voltage-dependent block by Mg2+ of NMDA responses in spinal cord neurones. Nature 1984; 309(5965): 261-3.
  25. O'Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of recent guidelines. Am J Med 2009; 122(10 Suppl): S22-32.
  26. Bettendorf B, Shay S, Tu F. Dysmenorrhea: contemporary perspectives. Obstet Gynecol Surv 2008; 63(9): 597-603.
  27. Russell MB, Levi N, Saltyte-Benth J, Fenger K. Tension-type headache in adolescents and adults: a population based study of 33,764 twins. Eur J Epidemiol 2006; 21(2): 153-60.
  28. Thomas J, Tomb E, Thomas E, Faure G. Migraine treatment by oral magnesium intake and correction of the irritation of buccofacial and cervical muscles as a side effect of mandibular imbalance. Magnes Res 1994; 7(2): 123-7.
  29. Guler A, Satilmis T, Akinci SB, Celebioglu B, Kanbak M. Magnesium sulfate pretreatment reduces myoclonus after etomidate. Anesth Analg 2005; 101(3): 705-9.
  30. Guo BL, Lin Y, Hu W, Zhen CX, Bao-Cheng Z, Wu HH, et al. Effects of systemic magnesium on post-operative analgesia: is the current evidence strong enough? Pain Physician 2015; 18(5): 405-18.
  31. Singhal S, Bharti D, Yadav S, Hayaran N. Effect of IV infusion of magnesium sulfate on postoperative pain after spinal anesthesia: a prospective randomized trial. Archives of Anesthesia and Critical Care 2021; 7(4): 209-15.
  32. Chen C, Tao R. The impact of magnesium sulfate on pain control after laparoscopic cholecystectomy: a meta-analysis of randomized controlled studies. Surg Laparosc Endosc Percutan Tech 2018; 28(6): 349-53.
  33. Zhang J, Wang Y, Xu H, Yang J. Influence of magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy: A meta-analysis of randomized controlled studies. Medicine (Baltimore) 2018; 97(45): e12747.
Journal of Isfahan Medical School
Volume 43, Issue 837
1st Week, January
January and February 2026
Pages 1401-1410

Files

History

  • Receive Date: 14 October 2024
  • Accept Date: 21 January 2026

Share

How to cite

Statistics