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Research article
Comparative evaluation of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia: a meta-analysis of randomized controlled trials
Hou-Zhong Zhang
Jilin University Second Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3438-4781
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background The comparative efficacy of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia remains controversial.Methods We searched Mediline (OvidSP), EMBASE (OvidSP) and Cochrane Central Register of Controlled Trials (CENTRAL) to identify trials that compared epidural bupivacaine and magnesium sulfate combination (intervention) with bupivacaine alone (control). Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework was used to assess the quality of evidence.Results Eleven studies fulfilled our inclusion criteria after screening. We found that epidural bupivacaine combined with magnesium sulfate could prolong the time for first rescue analgesics (SMD 4.96; 95% CI [2.75, 7.17], P<0.00001, I 2 = 98%), reduce the number of patients who need rescue analgesics (RR 0.38; 95% CI [0.20, 0.74], P = 0.004, I 2 = 75%) and requirement for rescue analgesics (SMD -2.65; 95% CI [-4.23, -1.06], P=0.001, I 2 = 96%).Conclusions Magnesium suifate as an adjuvant of epidural bupivacaine improved postoperative analgesia. However, we rated the quality of evidence to be very low because of high heterogeneity, imprecise of results and small sample sizes. Furthermore, further large high-quality trials are still needed to confirm the effects of magnesium sulfate on postoperative analgesia.
Keywords
Magnesium sulfate, Postoperative analgesia, Epidural anesthesia, Bupivacaine
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CURRENT STATUS: Under Review
Version 2
Posted 09 Jan, 2020
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Review #2 received
Received 19 Jan, 2020
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On 08 Jan, 2020
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Received 07 Jan, 2020
Editor assigned
On 06 Jan, 2020
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Invitations sent on 06 Jan, 2020
Reviewer #1 agreed
On 06 Jan, 2020
Submission checks complete
On 05 Jan, 2020
Editor invited
On 05 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 22 Dec, 2019
Review #1 received
Received 16 Dec, 2019
Review #2 received
Received 15 Dec, 2019
Reviewer #3 agreed
On 06 Dec, 2019
Reviewer #1 agreed
On 01 Dec, 2019
Reviewer #2 agreed
On 01 Dec, 2019
Reviewers invited
Invitations sent on 28 Nov, 2019
Editor assigned
On 25 Nov, 2019
Submission checks complete
On 24 Nov, 2019
Editor invited
On 24 Nov, 2019
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Subject Areas
Anesthesiology & Pain Medicine
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This preprint is under consideration at BMC Anesthesiology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Comparative evaluation of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia: a meta-analysis of randomized controlled trials
Hou-Zhong Zhang
Jilin University Second Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3438-4781
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 2
Posted 09 Jan, 2020
No community comments so far
Review #2 received
Received 19 Jan, 2020
Reviewer #2 agreed
On 08 Jan, 2020
Review #1 received
Received 07 Jan, 2020
Editor assigned
On 06 Jan, 2020
Reviewers invited
Invitations sent on 06 Jan, 2020
Reviewer #1 agreed
On 06 Jan, 2020
Submission checks complete
On 05 Jan, 2020
Editor invited
On 05 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 22 Dec, 2019
Review #1 received
Received 16 Dec, 2019
Review #2 received
Received 15 Dec, 2019
Reviewer #3 agreed
On 06 Dec, 2019
Reviewer #1 agreed
On 01 Dec, 2019
Reviewer #2 agreed
On 01 Dec, 2019
Reviewers invited
Invitations sent on 28 Nov, 2019
Editor assigned
On 25 Nov, 2019
Submission checks complete
On 24 Nov, 2019
Editor invited
On 24 Nov, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background The comparative efficacy of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia remains controversial.Methods We searched Mediline (OvidSP), EMBASE (OvidSP) and Cochrane Central Register of Controlled Trials (CENTRAL) to identify trials that compared epidural bupivacaine and magnesium sulfate combination (intervention) with bupivacaine alone (control). Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework was used to assess the quality of evidence.Results Eleven studies fulfilled our inclusion criteria after screening. We found that epidural bupivacaine combined with magnesium sulfate could prolong the time for first rescue analgesics (SMD 4.96; 95% CI [2.75, 7.17], P<0.00001, I 2 = 98%), reduce the number of patients who need rescue analgesics (RR 0.38; 95% CI [0.20, 0.74], P = 0.004, I 2 = 75%) and requirement for rescue analgesics (SMD -2.65; 95% CI [-4.23, -1.06], P=0.001, I 2 = 96%).Conclusions Magnesium suifate as an adjuvant of epidural bupivacaine improved postoperative analgesia. However, we rated the quality of evidence to be very low because of high heterogeneity, imprecise of results and small sample sizes. Furthermore, further large high-quality trials are still needed to confirm the effects of magnesium sulfate on postoperative analgesia.
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Figure 8