Intravenous magnesium sulfate for analgesia in spinal surgery: a systematic review and meta-analysis of randomized controlled trials
Authors' conclusion
Perioperative magnesium sulfate improves analgesia and reduces opioid consumption in spinal surgery, especially with a bolus-plus-infusion regimen. However, it may delay emergence and increase hypotension risk.
Study context
- Population
- Adults undergoing spinal surgery
- Participants
- 1,271 adults · 21 RCTs
- Comparison
- Perioperative IV magnesium sulfate vs control
- Outcome
- Postoperative pain scores and opioid consumption
- Follow-up
- 24 h
Methodological detailsGRADE certainty assessment, leave-one-out sensitivity analysis
- GRADE certainty assessment
- Leave-one-out sensitivity analysis
Pooled result
As reported in the abstract
Magnesium sulfate vs ControlMD (95% CI)P value
24-h pain scores
−0.55(−1.01 to - 0.10)
P = 0.02Magnesium sulfate vs ControlMD, mg (95% CI)P value
Opioid consumption
−4.95(−8.74 to - 1.15)
P = 0.01Further pooled results
Pain and opioid consumption by dosing regimen (subgroup)
- Effect more pronounced with loading dose plus maintenance dose
Intraoperative opioid consumption
- Significantly reduced with magnesium
PONV
- Lower incidence with magnesium sulfate vs control
Safety
Hypotension
- Higher incidence with magnesium sulfate vs control
Emergence (time to follow commands, time to recovery of orientation)
- Intraoperative IV magnesium appears to prolong both
Original publication
Intravenous magnesium sulfate for analgesia in spinal surgery: a systematic review and meta-analysis of randomized controlled trials. J Clin Anesth. Published 28 August 2026. doi:10.
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