Magnesium sulfate 1.24% (magnesium 0.05mmol/ml) solution for injection 10ml ampoules

BackgroundEffective pain management following spinal surgery is crucial for preventing complications related to delayed mobilization. Magnesium sulfate (MgSO4) has shown promise as an analgesic agent, influencing neurotransmitter modulation and autonomic nervous system regulation. However, studies evaluating its effectiveness and safety in spinal surgery remain inconsistent, necessitating a comprehensive meta-analysis to assess its role.ObjectiveThis study aimed to perform a systematic meta-analysis to compare the safety and efficacy of magnesium sulfate against standard therapeutic options in spinal surgery.MethodsThe meta-analysis followed PRISMA guidelines. We performed data extraction and analysis using Review Manager version 5.4. The study population included patients undergoing spinal surgery, with the intervention group receiving intravenous magnesium sulfate at varying dosages or in combination with other agents. The comparison group received either a placebo or alternative treatments. Primary outcomes included pain intensity, opioid consumption, and safety parameters.ResultsTen randomized controlled trials involving 641 patients were included. Magnesium sulfate administration significantly reduced pain scores at 24 h (MD -0.18, 95% CI: -0.34 to -0.02) and decreased opioid consumption (SMD -0.34, 95% CI: -1.07 to -0.35). Additionally, a significant reduction in muscle relaxant usage was observed (SMD -0.91, 95% CI: -0.66 to -0.10). When compared with dexmedetomidine, magnesium sulfate improved verbal response (MD 1.22, 95% CI: -0.16-2.61) and prolonged extubation time (MD 0.91, 95% CI: -0.98-2.80). No significant differences in hemodynamic parameters (heart rate and blood pressure) were observed between the groups.ConclusionIntravenous magnesium sulfate demonstrated significant benefits in reducing postoperative pain and opioid consumption, while also improving verbal response and orientation. These findings suggest that magnesium sulfate may serve as a valuable adjunct in the perioperative management of spinal surgery patients. Further research is required to confirm these results and establish optimal dosing protocols.

Abstract licence: CC BY

We conducted two systematic reviews including only randomized controlled trials (RCTs) comparing magnesium sulfate vs placebo/no treatment, as well as 2 g/h vs 1 g/h magnesium sulfate maintenance regimens for prevention of eclampsia. Medline, Cochrane Library, EMBASE, PubMed Central, Scopus, ClinicalTrial.gov were electronically searched from their inception to February 2025. In the five RCTs comparing magnesium sulfate vs placebo/no treatment, a 2-g maintenance dose was used in two RCTs including 176 pregnancies, while a 1 g maintenance dose was used in three RCTs including 5447 pregnancies. Eclampsia incidence was 0.57% with the 2 g/h regimen and 0.76% with the 1 g/h regimen (OR 1.33, 95% CI: 0.18-9.60), while maternal side effects were significantly higher in the 2 g/h regimen (67% vs 22%, OR 7.05, 95% CI: 4.22-11.78). In the five RCTs (n = 283) comparing 2 g/h vs 1 g/h maintenance regimens, no case of eclampsia was reported with either regimen, and maternal side effects were significantly higher in the 2 g/h group (71% vs 42%, OR 1.69, 95% CI: 1.06-2.71). In conclusion, magnesium sulfate maintenance regimen of 1 g/h seems as effective as the 2 g/h regimen for the prevention of eclampsia, with decreased incidence of maternal side effects.

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Asthma is a common cause of acute illness and healthcare utilization in children, and while intravenous magnesium sulfate is established in severe exacerbations, the clinical role of nebulized magnesium sulfate remains uncertain. This systematic review evaluated whether nebulized magnesium sulfate, used as an adjunct to standard therapy, improves clinical outcomes in pediatric acute asthma exacerbations. A comprehensive literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines, identifying studies published between January 2010 and November 2025. Seven studies were included: six randomized controlled trials and one systematic review with meta-analysis, all involving pediatric populations. Study selection, data extraction, and quality appraisal were performed using validated tools, including A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) and the Revised Cochrane Risk-of-Bias tool for randomised trials (RoB 2). Across the included studies, nebulized magnesium sulfate demonstrated variable and generally modest effects on asthma severity scores, with no consistent reduction in hospital admission rates, length of stay, or escalation of care. Safety findings were reassuring, with no serious treatment-related adverse events reported. Overall, current evidence does not demonstrate a clear or consistent additional clinical benefit of nebulized magnesium sulfate beyond standard therapy in pediatric acute asthma exacerbations. Future well-designed trials using standardized outcome measures and longer follow-up are required to clarify its role in contemporary pediatric asthma management.

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