Anesth Pain Med.  2020 Jan;15(1):88-95. 10.17085/apm.2020.15.1.88.

Additional effect of magnesium sulfate and vitamin C in laparoscopic gynecologic surgery for postoperative pain management: a double-blind randomized controlled trial

• Moon S
• Lim S
• Yun J
• Lee W
• Kim M
• Cho K
• Ki S

• KMID: 2500461
• DOI: http://doi.org/10.17085/apm.2020.15.1.88

Abstract

Background
This clinical trial was conducted to determine whether combined use of magnesium sulfate and vitamin C more significantly reduced postoperative fentanyl consumption and pain than magnesium sulfate or vitamin C alone.
Methods
The prospective, double-blinded, randomized controlled study enrolled 132 patients scheduled for laparoscopic gynecologic surgery. The patients were randomly allocated to one of the four groups (n = 33 for each group; Group M [magnesium sulfate 40 mg/kg], Group V [vitamin C 50 mg/kg], Group MV [magnesium sulfate 40 mg/kg and vitamin C 50 mg/kg] and Group C [isotonic saline 40 ml]). Cumulative postoperative fentanyl consumption (primary endpoint measure), postoperative pain score by numeric rating scale, and postoperative nausea and vomiting were recorded at 1, 6, 24, and 48 h after discharge from the postanesthesia care unit.
Results
Cumulative postoperative fentanyl consumption was significantly less in Groups M, V, and MV than in Group C at all time points. Group MV showed significantly less cumulative postoperative fentanyl consumption than Group M at postoperative 24 h (mean ± standard deviation, 156.6 ± 67.5 vs. 235.6 ± 94.6 μg, P = 0.001), as well as significantly less consumption than Groups M and V at postoperative 48 h (190.8 ± 74.6 vs. 301.0 ± 114.8 or 284.1 ± 128.6 μg, P < 0.001, P = 0.003, respectively).
Conclusions
Combined use of magnesium sulfate and vitamin C provides an additional benefit in postoperative pain management after laparoscopic gynecologic surgery in comparison to single administration of magnesium sulfate or vitamin C.

Keyword

Ascorbic acid; Laparoscopy; Magnesium sulfate; N-Methyl-D-Aspartate receptors; Postoperative pain

Figure

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  Fig. 1 CONSORT flow diagram. Group C: control group, Group M: magnesium sulfate group, Group V: vitamin C group, Group MV: magnesium sulfate + vitamin C group. PONV: postoperative nausea and vomiting.

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  Fig. 2 Cumulative fentanyl consumption. Mean cumulative injected fentanyl dose of the intravenous patient-controlled analgesia solution in the four groups. The error bars show standard deviation. Group C: control group, Group M: magnesium sulfate group, Group V: vitamin C group, Group MV: magnesium sulfate + vitamin C group. *Indicates significant difference between Group C and the other groups (P < 0.008). †Indicates significant difference between Group MV and Group M (P = 0.001, P < 0.001, 24 and 48 h after operation, respectively). ‡Indicates significant difference between Group MV and Group V (P = 0.003).

• 

  Fig. 3 Postoperative pain scores. Postoperative pain scores by numeric rating scale at 1, 6, 24, 48 h after surgery. Box plot with median (solid line), interquartile ranges (box) and values within 1.5 interquartile ranges from each side of the box (whiskers). Outliers are indicated by solid circles. Group C: control group, Group M: magnesium group, Group V: vitamin C group, Group MV: magnesium + vitamin C group. *Indicates significant difference between groups (P < 0.008).

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  Fig. 4 Incidence of postoperative nausea and vomiting. Values are presented as number (%). Group C: control group, Group M: magnesium group, Group V: vitamin C group, Group MV: magnesium + vitamin C group, PONV: postoperative nausea and vomiting. *Indicates significant difference between Group C and Group V (P = 0.001). †Indicates significant difference between Group C and Group V (P = 0.007).

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