Efficacy of magnesium sulfate as an adjuvant to local anesthetics in supraclavicular brachial plexus block: a meta-analysis of randomized trials
Eficácia do sulfato de magnésio como adjuvante a anestésicos locais no bloqueio do plexo braquial supraclavicular: uma metanálise de ensaios randomizados
Willyam Barros Saraiva, Isadora Eloy Candido, Roberta Ribeiro Brandão Caldas, Fabiano Timbó Barbosa
Abstract
Background
Magnesium Sulfate (MS) maintains physiological functions in the body. Studies suggest its safety in regional anesthesia, despite off-label perineural use. We conducted a systematic review and meta-analysis to evaluate MS efficacy as an adjuvant in supraclavicular brachial plexus block.
Methods
The study was registered in PROSPERO (CRD42025641627) on 01/21/2025. We searched PubMed, Embase, Cochrane, clinicaltrials.gov and gray literature for eligible studies.
We included RCTs that: enrolled adult patients; involved orthopedic surgery with supraclavicular block; compared LA alone versus LA with MS; and reported primary outcomes. Primary outcomes were duration of sensory and motor block, while secondary outcomes included onset of sensory and motor block, PONV and rescue analgesia needs postoperatively. RoB2 tool and GRADE assessed bias risk and evidence certainty. Variables were examined using DerSimonian-Laird random-effects model.
Results
Analysis included 10 studies and 734 patients. The intervention group showed longer sensory and motor block than controls. The Mean Difference (MD) was 180.84 minutes (95% CI [154.09, 207.59], 95% PI [71.67, 289.77], p < 0.00001, I2 = 97%) and 151.26 minutes (95% CI [99.78, 202.74], 95% PI [-23.12, 325.63], p < 0.00001, I2 = 99%). The magnesium group showed statistical difference in onset of sensory and motor blockade and rescue analgesia needs, with no difference in PONV. Evidence certainty was rated low to moderate. Risk of bias “high” in three studies, “some concerns” in four studies and “low” in three studies.
Conclusion
Our meta-analysis supports MS as adjuvant in supraclavicular block. Further research is needed due to high heterogeneity.
PROSPERO registration: CRD42025641627.
Keywords
Resumo
Introdução
O Sulfato de Magnésio (MS) mantém funções fisiológicas no organismo. Estudos sugerem sua segurança em anestesia regional, apesar do uso perineural off-label. Realizamos uma revisão sistemática e metanálise para avaliar a eficácia do MS como adjuvante no bloqueio supraclavicular do plexo braquial.
Métodos
O estudo foi registrado no PROSPERO (CRD42025641627) em 21/01/2025. Pesquisamos PubMed, Embase, Cochrane, clinicaltrials.gov e literatura cinzenta para estudos elegíveis. Incluímos RCTs que: recrutaram pacientes adultos; envolveram cirurgia ortopédica com bloqueio supraclavicular; compararam LA isolado versus LA com MS; e relataram desfechos primários. Os desfechos primários foram duração do bloqueio sensorial e motor, enquanto os secundários incluíram início do bloqueio sensorial e motor, PONV e necessidade de analgesia de resgate no pós-operatório. A ferramenta RoB2 e o GRADE avaliaram risco de viés e certeza da evidência. As variáveis foram examinadas usando o modelo de efeitos aleatórios de DerSimonian-Laird.
Resultados
A análise incluiu 10 estudos e 734 pacientes. O grupo de intervenção apresentou maior duração do bloqueio sensorial e motor em comparação aos controles. A Diferença Média (MD) foi de 180,84 minutos (CI 95% [154,09, 207,59], PI 95% [71,67, 289,77], p < 0,00001, I² = 97%) e 151,26 minutos (CI 95% [99,78, 202,74], PI 95% [−23,12, 325,63], p < 0,00001, I² = 99%). O grupo do magnésio apresentou diferença estatística no início do bloqueio sensorial e motor e na necessidade de analgesia de resgate, sem diferença em PONV. A certeza da evidência foi classificada como baixa a moderada. O risco de viés foi “alto” em três estudos, “algumas preocupações” em quatro estudos e “baixo” em três estudos.
Conclusion
Nossa metanálise reforça o MS como adjuvante no bloqueio supraclavicular. Mais pesquisas são necessárias devido à alta heterogeneidade.
Registro PROSPERO: CRD42025641627.
Palavras-chave
References
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Submitted date:
02/24/2025
Accepted date:
08/17/2025
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