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Anesth Analg. Author manuscript; available in PMC 2016 December 01. Published in final edited form as: Anesth Analg. 2015 December ; 121(6): 1627–1631. doi:10.1213/ANE.0000000000001028.

The Effect of Systemic Magnesium on Postsurgical Pain in Children Undergoing Tonsillectomies: A Double-Blinded, Randomized, Placebo-Controlled Trial Hubert A. Benzon, MD, MPH, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois

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Ravi D. Shah, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois Jennifer Hansen, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois John Hajduk, BS, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois Kathleen R. Billings, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois Gildasio S. De Oliveira Jr., MD, MSCI, and

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Corresponding Author: Gildasio S. De Oliveira Jr. MD, MSCI, Associate Chair for Research, Department of Anesthesiology, Northwestern University, 241 East Huron St F5-704, Chicago, Illinois 60611, Phone: 312-472-3573, [email protected] The authors declare no conflicts of interest. Reprints will not be available from the authors.

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Disclosures Name: Hubert A. Benzon, MD, MPH Contribution: This author contributed for study design, conduct of the study and manuscript preparation. Attestation: Hubert Benzon approved the final manuscript. Hubert Benzon attests to the integrity of the original data and the analysis reported in this manuscript. Hubert Benzon is the archival author. Name: Ravi D. Shah, MD Contribution: This author contributed for study design, conduct of the study and manuscript preparation. Attestation: Ravi D. Shah approved the final manuscript. Ravi D. Shah attests to the integrity of the original data and the analysis reported in this manuscript. Name: Jennifer Hansen, MD Contribution: This author contributed for conduct of the study and manuscript preparation. Attestation: Jennifer Hansen approved the final manuscript. Name: John Hajduk, BS Contribution: This author contributed for conduct of the study and manuscript preparation. Attestation: John Hajduk approved the final manuscript. John Hajduk attests to the integrity of the original data and the analysis reported in this manuscript. Name: Kathleen R. Billings, MD Contribution: This author contributed for conduct of the study and manuscript preparation. Attestation: Kathleen R. Billings approved the final manuscript. Name: Gildasio S. De Oliveira Jr., MD, MSCI Contribution: This author contributed for study design, statistical analysis and manuscript preparation. Attestation: Gildasio S. De Oliveira Jr. approved the final manuscript. Gildasio S. De Oliveira Jr. attests to the integrity of the original data and the analysis reported in this manuscript. Name: Santhanam Suresh, MD Contribution: This author contributed for study design, conduct of the study and manuscript preparation. Attestation: Santhanam Suresh approved the final manuscript. This manuscript was handled by: Spencer S. Liu, MD

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Department of Anesthesiology, Northwestern University, Chicago, Illinois

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Santhanam Suresh, MD Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois

Abstract

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Introduction—Tonsillectomy is a frequently performed surgical procedure in children; however few multimodal analgesic strategies have been shown to improve postsurgical pain in this patient population. Systemic magnesium infusions have been shown to reliably improve postoperative pain in adults, but its effects in pediatric surgical patients remains to be determined. In the current investigation our main objective was to evaluate the use of systemic magnesium to improve postoperative pain in pediatric patients undergoing tonsillectomy. We hypothesized that children who received systemic magnesium infusions would have less post-tonsillectomy pain than the children who received saline infusions. Methods—The study was a prospective, randomized, double-blinded, clinical trial. Subjects were randomized using a computer-generated table of random numbers to one of the two intervention groups: systemic magnesium infusion (initial loading dose 30 mg/kg given over 15 minutes followed by a continuous magnesium infusion 10 mg/kg/hr) or the same volume of saline. The primary outcome was pain scores in the postanesthesia care unit (PACU) measured by FLACC pain scores. Pain reduction was measured by the decrement in the area under the pain scale versus 90-minute postoperative time curve using the trapezoidal method. Secondary outcomes included opioid consumption in the PACU, emergence delirium scores (measured by the pediatric anesthesia emergence delirium scale) and parent satisfaction.

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Results—Sixty subjects were randomized and 60 completed the study. The area under pain scores (up to 90 minutes) was not different between the study groups, median (IQR) of 30 (0 to 120) score*min and 45 (0 to 135) score*min for the magnesium and control groups, respectively, P= 0.74. Similarly, there was no clinically significant difference in the morphine consumption in the PACU between the magnesium group, median (IQR) of 2.0 (0 to 4.44) mg IV morphine compared to control, median (IQR) of 2.5 (0 to 4.99) mg IV morphine, P= 0.25. The serum level of magnesium was significantly lower in the control group compared to the treatment group at the end of the surgery (P0.1). Normally distributed interval data are reported as mean (SD) and were analyzed using independent student’s t test. Non-normally distributed interval and ordinal

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data are reported as median (range or Interquartile range (IQR)) and were analyzed using the Mann-Whitney U test. The Wilcoxon-Mann-Whitney odds and 95% CI for a random pair for pain score (area under the curve) and morphine consumption values from the magnesium and the saline group were determined from the area under the receiver operator characteristic curve from the binary logistic model.22,23 Categorical data are presented as counts (n) and were analyzed using Fisher’s exact test. Data were analyzed using STATA version 12 (College Station, Texas, USA).

Results

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Sixty children undergoing tonsillectomy with or without adenoidectomy surgery were recruited to the study between October 1, 2014 and April 30, 2015. The details of the conduct of the study are presented in Figure 1. There were no differences in baseline characteristics between the study groups (Table 1).

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The serum level of magnesium was significantly different between the study groups at the end of the surgery (P

The Effect of Systemic Magnesium on Postsurgical Pain in Children Undergoing Tonsillectomies: A Double-Blinded, Randomized, Placebo-Controlled Trial.

Tonsillectomy is a frequently performed surgical procedure in children; however, few multimodal analgesic strategies have been shown to improve postsu...
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