Effectiveness of Magnesium in Preventing Shivering in Surgical Patients: A Systematic Review and Meta-analysis

Abstract

BACKGROUND: Clinical trials regarding the antishivering effect of perioperative magnesium have produced inconsistent results. We conducted a systematic review and meta-analysis with Trial Sequential Analysis to evaluate the effect of perioperative magnesium on prevention of shivering. METHODS: We searched PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and 2 registry sites for randomized clinical trials that compared the administration of magnesium to a placebo or no treatment in patients undergoing surgeries. The primary outcome of this meta-analysis was the incidence of shivering. The incidence of shivering was combined as a risk ratio with 95% CI using a random-effect model. The effect of the route of administration was evaluated in a subgroup analysis, and Trial Sequential Analysis with a risk of type 1 error of 5% and power of 90% was performed. The quality of each included trial was evaluated, and the quality of evidence was assessed using the Grading of Recommendation Assessment, Development, and Evaluation approach. We also assessed adverse events. RESULTS: Sixty-four trials and 4303 patients (2300 and 2003 patients in magnesium and control groups, respectively) were included. The overall incidence of shivering was 9.9% in the magnesium group and 23.0% in the control group (risk ratio, 0.42; 95% CI, 0.33–0.52). Subgroup analysis revealed that the incidence of shivering was lower with IV (risk ratio, 0.29; 95% CI, 0.29–0.54; Grading of Recommendation Assessment, Development, and Evaluation, moderate), epidural (risk ratio, 0.24; 95% CI, 0.13–0.43; Grading of Recommendation Assessment, Development, and Evaluation, low), and intrathecal administration (risk ratio, 0.64; 95% CI, 0.43–0.96; Grading of Recommendation Assessment, Development, and Evaluation, moderate). Only trials with low risk of bias were included for Trial Sequential Analysis. The Z-cumulative curve for IV magnesium crossed the Trial Sequential Analysis monitoring boundary for benefit even though only 34.9% of the target sample size had been reached. The Z-cumulative curve for epidural or intrathecal administration did not cross the Trial Sequential Analysis monitoring boundary for benefit. No increase in adverse events was reported. CONCLUSIONS: Perioperative IV administration of magnesium effectively reduced shivering and Trial Sequential Analysis suggested that no more trials are required to confirm that IV magnesium effectively reduces shivering.

The role of magnesium in perioperative management of intracranial aneurysm surgery: A case series

“…[ 9 ] Lastly, reduced incidence of postoperative shivering, PONV (as in the present case-series) and correction of underlying hypomagnesemia collectively contribute to an augmented postoperative recovery. [ 10 ] Nevertheless, it becomes imperative to employ neuromuscular monitoring as Mg infusion can potentiate and prolong the neuromuscular blockade.…”

Role of magnesium sulfate in the treatment of acute postoperative pain

“…Deksmedetomidin je efikasan i bezbedan (88), ali magnezijum je značajno jeftiniji od deksmedetomidina. Meta-analiza šest randomizovanih kontrolisanih ispitivanja (247 pacijenata) pokazala je da u kaudalnoj anesteziji kod pedijatrijskih pacijenata dodavanje 50 mg magnezijuma ropivakainu značajno produžava trajanje anestezije i smanjuje potrebu za analgeticima (paracetamol), bez povećanja neželjenih efekata (89). Budući da pacijentima nije davan opioid intraoperativno, ili intravenski ili kaudalno, opioidi nisu uključeni u analgetski efekat kaudalno primenjenog magnezijuma.…”

“…Kaudalni magnezijum može biti koristan za smanjenje potrebe za dodatnim analgeticima nakon operacije, ali kvalitet dokaza u literaturi je vrlo nizak, a kaudalno davanje magnezijuma još uvek se smatra eksperimentalnim. Nove dobro osmišljene studije su neophodne za donošenje definitivnih zaključaka (89).…”

“…Nedavno je jedna prospektivna deskriptivna studija preseka pokazala da je u Brazilu magnezijum-sulfat jedan od 5 najčešće korišćenih pomoćnih lekova u anesteziji, pored klonidina, ketamina, lidokaina i deksmedetomidina (9). Primenjen perioperativno, magnezijum-sulfat može da smanji potrebe za opštim anestetikom (37, 38, 39 26, 27, 28), poboljša postoperativnu analgeziju (40,41), smanji potrebu za opioidnim analgetikom (41), ublaži kardiovaskularne efekte kod laringoskopije, intubacije, kao i kod stvaranja pneumoperitoneuma pre videolaparaskopije (42,43), obezbedi bolju hemodinamsku kontrolu pri resekciji feohromocitoma (44), spreči pojavu vazospazma (45), produži dejstvo miorelaksansa i smanji potrebu za miorelaksansom (9,46), kao i smanji postoperativnu drhtavicu (47,48,49). Pri svemu tome, magnezijum-sulfat ima visok terapijski indeks, malo neželjenih efekata i mogao bi da ima povoljan odnos cene i efikasnosti (17).…”

A comparative Study Between Pethidine, Granisetron and Tramadol in Prophylaxis Against Perioperative Shivering After Spinal Anesthesia

“…The list of drugs with antishivering effects include dexmedetomidine [8] , 5hydroxytryptamine-3 receptor antagonists [9] , meperidine [10] , fentanyl, buprenorphine, doxapram, clonidine [11] . However, these drugs were not widely used due to its high cost and their safety is disputed [12] .…”