Effect of intravenous infusion of magnesium sulfate on opioid use and hemodynamic status after hysterectomy: double-blind clinical trial

Document Type : Original Article


1 M.Sc. in Internal-Surgery Nursing Education, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.

2 Associate Professor, Department of Anesthesia, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.


Introduction: Due to adverse effects of injection opioids after surgeries such as hysterectomy and also, controversial results, the most appropriate method for using magnesium sulfate to minimize the postoperative opioid use, this study was performed with aim to determine the effect of intravenous infusion of magnesium sulfate on opioid use and hemodynamic status after hysterectomy.
Methods: This double-blind clinical trial was conducted on 60 patients who were candidates for hysterectomy in Tabriz Imam Reza Hospital in 2018. The subjects were randomly divided into intervention and control groups. For the intervention group, half an hour before anesthesia, 50mg/kg magnesium sulfate was injected as bolus to the patients. After the end of surgery, and patients' discharge from the recovery unit, infusion of magnesium sulfate 500mg/hr continued for up to 24 hours after surgery. The hemodynamic status of patients and opioid use were recorded in the researcher-made checklist. Data were analyzed by SPSS software (version 19) and Mann-Whitney U and t-test. P <0.05 was considered statistically significant.
Results: There was a significant difference in hemodynamic status of patients in both groups at all times, so that the intervention group had a more stable status (maximum P value was 0.04), also, the opioid use in the intervention group was associated with a decrease over time, while no significant decrease was observed in the control group.
Conclusion: The use of magnesium sulfate leads to the stability of hemodynamic status and reduces the need for opioid, but it cannot minimize the need for opioids after hysterectomy.


  1. Andreae MH, Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a cochrane systematic review and meta-analysis. Surv Anesthesiol 2014; 58(4):203.
  2. Navali N, Mallah F, Bastani P, Mashrabi O. Comparing therapeutic effects of Metformin and Pioglitazone in Polycystic ovary syndrome (PCOS). Pakistan Journal of Medical Sciences. 2012;28(3):390-4.
  3. Mallah F, Nazari F, Navali N, Hajipour B. Comparison of direct visual inspection (DVI) with pap smear in diagnosis of precancerous lesion of cervix. Life Science Journal. 2012;9(4):2556-60.
  4. Mallah F, Tasbihi P, Navali N, Azadi A. Urinary incontinence during pregnancy and postpartum incidence, severity and risk factors in Alzahra and Taleqani hospitals in Tabriz, Iran, 2011-2012. International Journal of Women's Health and Reproduction Sciences. 2014;2(3):178-85.
  5. VanDenKerkhof EG, Hopman WM, Goldstein DH, Wilson RA, Towheed TE, Lam M, et al. Impact of perioperative pain intensity, pain qualities, and opioid use on chronic pain after surgery: a prospective cohort study. Reg Anesth Pain Med 2012; 37(1):19-27.
  6. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: a clinical practice guideline from the American pain society, the American society of regional anesthesia and pain medicine, and the American society of anesthesiologists' committee on regional anesthesia, executive committee, and administrative council. J Pain 2016; 17(2):131-57.
  7. Bakhshaei MH, Manuchehrian N, Khoshraftar E, Mohamadipour-Anvary H, Sanatkarfar M. Analgesic effects of intrathecal sufentanil added to lidocaine 5% in elective cesarean section. Acta Med Iran 2010; 48(6):380-4.
  8. Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth 2014; 112(6):991-1004.
  9. Zomorrodi A, Mohammadipoor Anvari H, Kakaei F, Solymanzadeh F, Khanlari E, Bagheri A. Bolus injection versus infusion of furosemide in kidney transplantation: a randomized clinical trial. Urol J 2017; 14(2):3013-7.
  10. Movassaghi R, Peirovifar A, Aghamohammadi D, Mohammadipour Anvari H, Golzari SE, Kourehpaz Z. Premedication with single dose of acetazolamide for the control of referral shoulder pain after laparoscopic cholecystectomy. Anesthesiol Pain Med 2015; 5(6):e29366.
  11. Clay L, Gunnarsson U, Franklin KA, Strigård K. Effect of an elastic girdle on lung function, intra-abdominal pressure, and pain after midline laparotomy: a randomized controlled trial. International journal of colorectal disease. 2014;29(6):715-21.
  12. Bastani P, Shoari N, HAJEBRAHIMI S, Mallah F, Azadi A. Comparison of performing and not-performing the prophylactic surgery for urinary incontinence in advanced pelvic organ prolapse. 2014;2(5): 311-315..
  13. Ziyadi S, Bastani P, Homayouni A, Mohammad-Alizadeh-Charandabi S, Mallah F. Probiotics and usage in urinary tract infection. Probiotics prebiotics and synbiotics: Bioactive foods in health promotion Elsevier Inc, London. 2016:827-30.
  14. Albrecht E, Kirkham K, Liu S, Brull R. Peri‐operative intravenous administration of magnesium sulphate and postoperative pain: a meta‐analysis. Anaesthesia 2013; 68(1):79-90.
  15. Albrecht E, Kirkham K, Liu S, Brull R. The analgesic efficacy and safety of neuraxial magnesium sulphate: a quantitative review. Surv Anesthesiol 2014; 58(4):200-1.
  16. Yadava A, Rajput SK, Katiyar S, Jain RK. A comparison of intraperitoneal bupivacaine-tramadol with bupivacaine-magnesium sulphate for pain relief after laparoscopic cholecystectomy: a prospective, randomised study. Indian J Anaesth 2016; 60(10):757-62.
  17. Murphy JD, Paskaradevan J, Eisler LL, Ouanes JP, Tomas VA, Freck EA, et al. Analgesic efficacy of continuous intravenous magnesium infusion as an adjuvant to morphine for postoperative analgesia: a systematic review and meta-analysis. Middle East J Anaesthesiol 2013; 22(1):11-20.
  18. De Oliveira GS, Castro-Alves LJ, Khan JH, McCarthy RJ. Perioperative systemic magnesium to minimize postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology 2013; 119(1):178-90.
  19. Jarahzadeh MH, Harati ST, Babaeizadeh H, Yasaei E, Bashar FR. The effect of intravenous magnesium sulfate infusion on reduction of pain after abdominal hysterectomy under general anesthesia: a double-blind, randomized clinical trial. Electron Physician 2016; 8(7):2602-6.
  20. Rasooli S, Parish M, Mahmoodpoor A, Moslemi F, Sanaie S, Faghfuri S. The effect of intramuscular ephedrine in prevention of hypotension due to propofol. PAKISTAN JOURNAL OF MEDICAL SCIENCES. 2007;23(6):893-897.
  21. Sadeghi-Bazargani H, Samadirad B, Moslemi F. A decade of road traffic fatalities among the elderly in north-West Iran. BMC public health. 2018;18(1):111.
  22. Mobaraki N, Yousefian M, Seifi S, Sakaki M. A randomized controlled trial comparing use of enthonox with pethidine for pain relief in primigravid women during the active phase of labor. Anesthesiology and Pain Medicine. 2016;6(4): e37420.
  23. Rad AH, Azizi A, Darghahi R, Bakhtiari O, Javadi M, Moghaddam MJ, et al. Development of Synbiotic Milk Chocolate Enriched with Lactobacillus paracasei, D-tagatose and Galactooligosaccharide. Applied Food Biotechnology. 2018;5(2):59-68.
  24. Mobaraki N, Kahnamouei-Aghdam F, Amani F, Mahami S. Comparing the Effectiveness of Intravenous Oxytocin Versus Rectal Misoprostol in the Management of Third-Stage of Labour After Second-Trimester Abortion. International Journal of Women's Health and Reproduction Sciences. 2016;4(4):181-4.
  25. Dargahi R, Shahbazzadegan S, Naghizadeh-Baghi A, Sefati Kooyakhi S. Expression levels of Drosha and Dicer enzymes and DGCR8 protein in pre-eclamptic patients. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2018;20(12):40-9.
  26. Darghahi R, Mobaraki-Asl N, Ghavami Z, Pourfarzi F, Hosseini-Asl S, Jalilvand F. Effect of cell-free fetal DNA on spontaneous preterm labor. Journal of Advanced Pharmaceutical Technology & Research. 2019;10(3):117-120.
  27. Kiaee MM, Safari S, Movaseghi GR, Dolatabadi MR, Ghorbanlo M, Etemadi M, et al. The effect of intravenous magnesium sulfate and lidocaine in hemodynamic responses to endotracheal intubation in elective coronary artery bypass grafting: a randomized controlled clinical trial. Anesthesiol Pain Med 2014; 4(3):e15905.
  28. Egelund TA, Wassil SK, Edwards EM, Linden S, Irazuzta JE. High-dose magnesium sulfate infusion protocol for status asthmaticus: a safety and pharmacokinetics cohort study. Intensive Care Med 2013; 39(1):117-22.
  29. Kiraci G, Demirhan A, Tekelioglu UY, Akkaya A, Bilgi M, Erdem A, et al. A comparison of the effects of lidocaine or magnesium sulfate on hemodynamic response and QT dispersion related with intubation in patients with hypertension. Acta Anaesthesiol Belg 2014; 65(3):81-6.
  30. Kumar M, Dayal N, Rautela RS, Sethi AK. Effect of intravenous magnesium sulphate on postoperative pain following spinal anesthesia. A randomized double blind controlled study. Middle East J Anesthesiol 2013; 22(3):251-6.
  31. Mercieri M, De Blasi R, Palmisani S, Forte S, Cardelli P, Romano R, et al. Changes in cerebrospinal fluid magnesium levels in patients undergoing spinal anaesthesia for hip arthroplasty: does intravenous infusion of magnesium sulphate make any difference? A prospective, randomized, controlled study. Br J Anaesth 2012; 109(2):208-15.
  32. Taheri A, Haryalchi K, Mansour Ghanaie M, Habibi Arejan N. Effect of low-dose (single-dose) magnesium sulfate on postoperative analgesia in hysterectomy patients receiving balanced general anesthesia. Anesthesiol Res Pract 2015; 2015:306145.
  33. El-Rahman AMA. Efficacy of magnesium sulfate added to local anesthetic in a transversus abdominis plane block for analgesia following total abdominal hysterectomy: A Randomized trial. Pain physician. 2017;20(7):641-7.