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J Reconstr Microsurg 2024; 40(07): 559-565
DOI: 10.1055/a-2253-9008
Original Article

Postoperative Magnesium Sulfate Repletion Decreases Narcotic Use in Abdominal-Based Free Flap Breast Reconstruction

Yi-Hsueh Lu
1   Division of Plastic Surgery, Montefiore Medical Center, Bronx, New York
,
Jini Jeon
2   Division of Plastic Surgery, Albert Einstein College of Medicine, Bronx, New York
,
Lakshmi Mahajan
2   Division of Plastic Surgery, Albert Einstein College of Medicine, Bronx, New York
,
Yufan Yan 
1   Division of Plastic Surgery, Montefiore Medical Center, Bronx, New York
,
Katie E. Weichman
3   Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
,
Joseph A. Ricci
4   Department of Plastic Surgery, Northwell Health, Hofstra School of Medicine, Great Neck, New York
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Abstract

Background Microsurgical breast reconstruction after mastectomy is now the standard of care for breast cancer patients. However, the costs and resources involved in free flap reconstruction can vary across different medical settings. To enhance patient outcomes in a cost-effective manner, we investigated the effect of intravenous magnesium sulfate (IV Mg) on postoperative opioid usage in this context.

Methods A retrospective chart review was performed on all consecutive patients who underwent abdominal-based free flap breast reconstruction in a single institute following an enhanced recovery after surgery (ERAS) protocol. Patients who received IV Mg were compared with those who did not receive supplementation. Serum magnesium levels at different time points, narcotic consumption in units of oral morphine milligram equivalents (MMEs), and other postoperative recovery parameters were compared.

Results Eighty-two patients were included. Those who received IV Mg on postoperative day 0 (n = 67) showed significantly lower serum magnesium levels before repletion (1.5 vs. 1.7 mg/dL, p = 0.004) and significantly higher levels on postoperative day 1 after repletion (2.2 vs. 1.7 mg/dL, p = 0.0002) compared to patients who received no magnesium repletion (n = 13). While both groups required a similar amount of narcotics on postoperative day 0 (20.2 vs. 13.2 MMEs, p = 0.2), those who received IV Mg needed significantly fewer narcotics for pain control on postoperative day 1 (12.2 MMEs for IV Mg vs. 19.8 MMEs for No Mg, p = 0.03). Recovery parameters, including maximal pain scores, postoperative mobilization, and length of hospital stay, did not significantly differ between the two groups.

Conclusion This is the first study to describe the potential analgesic benefits of routine postoperative magnesium repletion in abdominal-based free flap reconstruction. Further research is necessary to fully understand the role of perioperative magnesium supplementation as part of an ERAS protocol.

Keywords

magnesium sulfate - enhanced recovery after surgery (ERAS) - autologous breast reconstruction


Publikationsverlauf

Eingereicht: 15. Oktober 2023

Angenommen: 08. Januar 2024

Accepted Manuscript online:
25. Januar 2024

Artikel online veröffentlicht:
23. Februar 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Offodile II AC, Gu C, Boukovalas S. et al. Enhanced recovery after surgery (ERAS) pathways in breast reconstruction: systematic review and meta-analysis of the literature. Breast Cancer Res Treat 2019; 173 (01) 65-77
    CrossrefPubMedGoogle Scholar
  • 2 Temple-Oberle C, Shea-Budgell MA, Tan M. et al; ERAS Society. Consensus review of optimal perioperative care in breast reconstruction: Enhanced Recovery after Surgery (ERAS) Society recommendations. Plast Reconstr Surg 2017; 139 (05) 1056e-1071e
    CrossrefPubMedGoogle Scholar
  • 3 O'Neill A, Lirk P. Multimodal analgesia. Anesthesiol Clin 2022; 40 (03) 455-468
    CrossrefPubMedGoogle Scholar
  • 4 Shin HJ, Na HS, Do SH. Magnesium and pain. Nutrients 2020; 12 (08) 2184
    CrossrefPubMedGoogle Scholar
  • 5 Kulik K, Żyżyńska-Granica B, Kowalczyk A, Kurowski P, Gajewska M, Bujalska-Zadrożny M. Magnesium and morphine in the treatment of chronic neuropathic pain-a biomedical mechanism of action. Int J Mol Sci 2021; 22 (24) 13599
    CrossrefPubMedGoogle Scholar
  • 6 Karhu E, Atlas SE, Gao J. et al. Intravenous infusion of magnesium sulfate is not associated with cardiovascular, liver, kidney, and metabolic toxicity in adults. J Clin Transl Res 2018; 4 (01) 47-55
    PubMedGoogle Scholar
  • 7 Soleimanpour H, Imani F, Dolati S, Soleimanpour M, Shahsavarinia K. Management of pain using magnesium sulphate: a narrative review. Postgrad Med 2022; 134 (03) 260-266
    CrossrefPubMedGoogle Scholar
  • 8 Gupta K, Vohra V, Sood J. The role of magnesium as an adjuvant during general anaesthesia. Anaesthesia 2006; 61 (11) 1058-1063
    CrossrefPubMedGoogle Scholar
  • 9 Dubé L, Granry JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anaesth 2003; 50 (07) 732-746
    CrossrefPubMedGoogle Scholar
  • 10 De Oliveira Jr 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 (01) 178-190
    CrossrefPubMedGoogle Scholar
  • 11 Choi GJ, Kim YI, Koo YH, Oh HC, Kang H. Perioperative magnesium for postoperative analgesia: an umbrella review of systematic reviews and updated meta-analysis of randomized controlled trials. J Pers Med 2021; 11 (12) 1273
    CrossrefPubMedGoogle Scholar
  • 12 Chernow B, Bamberger S, Stoiko M. et al. Hypomagnesemia in patients in postoperative intensive care. Chest 1989; 95 (02) 391-397
    CrossrefPubMedGoogle Scholar
  • 13 Jiang P, Lv Q, Lai T, Xu F. Does hypomagnesemia impact on the outcome of patients admitted to the intensive care unit? A systematic review and meta-analysis. Shock 2017; 47 (03) 288-295
    CrossrefPubMedGoogle Scholar
  • 14 UpToDate. Accessed April 19, 2023 at: https://www.uptodate.com/contents/image?imageKey=PALC%2F111216
    PubMed
  • 15 Abu Sabaa MA, Elbadry AA, Hegazy S, El Malla DA. Intravenous versus wetting solution magnesium sulphate to counteract epinephrine cardiac adverse events in abdominal liposuction: a randomized controlled trial. Anesth Pain Med 2022; 12 (05) e129807
    CrossrefPubMedGoogle Scholar
  • 16 De Oliveira GS, Bialek J, Fitzgerald P, Kim JYS, McCarthy RJ. Systemic magnesium to improve quality of post-surgical recovery in outpatient segmental mastectomy: a randomized, double-blind, placebo-controlled trial. Magnes Res 2013; 26 (04) 156-164
    CrossrefPubMedGoogle Scholar
  • 17 Yazdi AP, Esmaeeli M, Gilani MT. Effect of intravenous magnesium on postoperative pain control for major abdominal surgery: a randomized double-blinded study. Anesth Pain Med 2022; 17 (03) 280-285
    CrossrefPubMedGoogle Scholar
  • 18 Ryu JH, Kang MH, Park KS, Do SH. Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia. Br J Anaesth 2008; 100 (03) 397-403
    CrossrefPubMedGoogle Scholar
  • 19 Lu JF, Nightingale CH. Magnesium sulfate in eclampsia and pre-eclampsia: pharmacokinetic principles. Clin Pharmacokinet 2000; 38 (04) 305-314
    CrossrefPubMedGoogle Scholar
  • 20 Van Laecke S. Hypomagnesemia and hypermagnesemia. Acta Clin Belg 2019; 74 (01) 41-47
    CrossrefPubMedGoogle Scholar
  • 21 Rodnoi P, Dickey RM, Teotia SS, Haddock NT. Increased opioid consumption following DIEP flap breast reconstruction: effect of depression and anxiety. J Reconstr Microsurg 2022; 38 (09) 742-748
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 22 Sebai ME, Siotos C, Payne RM. et al. Enhanced recovery after surgery pathway for microsurgical breast reconstruction: a systematic review and meta-analysis. Plast Reconstr Surg 2019; 143 (03) 655-666
    CrossrefPubMedGoogle Scholar
  • 23 Rodnoi P, Teotia SS, Haddock NT. Economic impact of refinements in ERAS pathways in DIEP flap breast reconstruction. J Reconstr Microsurg 2022; 38 (07) 524-529
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 24 Haddock NT, Garza R, Boyle CE, Teotia SS. Observations from implementation of the ERAS protocol after DIEP flap breast reconstruction. J Reconstr Microsurg 2022; 38 (06) 506-510
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 25 Haddock NT, Garza R, Boyle CE, Liu Y, Teotia SS. Defining enhanced recovery pathway with or without liposomal bupivacaine in DIEP flap breast reconstruction. Plast Reconstr Surg 2021; 148 (05) 948-957
    CrossrefPubMedGoogle Scholar
  • 26 Negru AG, Pastorcici A, Crisan S, Cismaru G, Popescu FG, Luca CT. The role of hypomagnesemia in cardiac arrhythmias: a clinical perspective. Biomedicines 2022; 10 (10) 2356
    CrossrefPubMedGoogle Scholar