Is intra-articular magnesium effective for postoperative analgesia in arthroscopic shoulder surgery?

Abstract

BACKGROUND: Various medications are used intra-articularly for postoperative pain reduction after arthroscopic shoulder surgery. Magnesium, a N-methyl-D-aspartate receptor antagonist, may be effective for reduction of both postoperative pain scores and analgesic requirements. METHODS: A total of 67 patients undergoing arthroscopic shoulder surgery were divided randomly into two groups to receive intra-articular injections of either 10 mL magnesium sulphate (100 mg/mL; group M, n=34) or 10 mL of normal saline (group C, n=33). The analgesic effect was estimated using a visual analogue scale 1 h, 2 h, 6 h, 8 h, 12 h, 18 h and 24 h after operation. Postoperative analgesia was maintained by intra-articular morphine (0.01%, 10 mg) + bupivacaine (0.5%, 100 mL) patient-controlled analgesia device as a 1 mL infusion with a 1 mL bolus dose and 15 min lock-out time; for visual analogue scale scores >5, intramuscular diclofenac sodium 75 mg was administered as needed during the study period (maximum two times). RESULTS: Intra-articular magnesium resulted in a significant reduction in pain scores in group M compared with group C 1 h, 2 h, 6 h, 8 h and 12 h after the end of surgery, respectively, at rest and with passive motion. Total diclofenac consumption and intra-articular morphine + bupivacaine consumption were significantly lower in group M. Postoperative serum magnesium levels were significantly higher in group M, but were within the normal range. CONCLUSIONS: Magnesium causes a reduction in postoperative pain in comparison to saline when administered intra-articularly after arthroscopic shoulder surgery, and has no serious side effects.