Magnesium Sulfate Attenuate Opioid Tolerance in Patients undergoing Major Abdominal Surgery

주요 복강수술 환자에서 황산 마그네슘의 아편유사제 내성 감소에 대한 효과

  • Jang, Mi Soon (Department of Anesthesiology and Pain Medicine, College of Medicine, Wonkwang University) ;
  • Son, Yong (Department of Anesthesiology and Pain Medicine, College of Medicine, Wonkwang University) ;
  • Lee, Cheol (Department of Anesthesiology and Pain Medicine, College of Medicine, Wonkwang University) ;
  • Lee, Ju Hwan (Department of Anesthesiology and Pain Medicine, College of Medicine, Wonkwang University) ;
  • Park, Jeong Hyun (Department of Internal Medicine, Sanbon Hospital, College of Medicine, Wonkwang University) ;
  • Lee, Myeong Jong (Department of Anesthesiology and Pain Medicine, Chungju Hospital, College of Medicine, Konkuk University)
  • 장미순 (원광대학교 의과대학 마취통증의학교실) ;
  • 손용 (원광대학교 의과대학 마취통증의학교실) ;
  • 이철 (원광대학교 의과대학 마취통증의학교실) ;
  • 이주환 (원광대학교 의과대학 마취통증의학교실) ;
  • 박정현 (원광대학교 의과대학 산본병원 내과학교실) ;
  • 이명종 (건국대학교 의과대학 충주병원 마취통증의학교실)
  • Received : 2009.02.12
  • Accepted : 2009.04.01
  • Published : 2009.04.01


Background: Magnesium is a noncompetitive antagonist of the N-methyl-D aspartate (NMDA) receptor. Magnesium is thought to be involved in opioid tolerance by way of inhibiting calcium entry into cells. Methods: The patients were randomly assigned to three groups according to the anesthetic regimens: Group M received magnesium sulfate and Group C received saline intravenously under remifentanil-based anesthesia. Group S received saline intravenously under sevoflurane based anesthesia in place of remifentanil. The patients in the group M received 25% magnesium sulfate 50 mg/kg in 100 ml of saline, and those patients in groups C and S received an equal volume of saline before induction of anesthesia; this was followed by 10 mg/kg/h infusion of either magnesium sulfate (group M) or an equal volume of saline (groups C and S) until the end of surgery. Pain was assessed on a visual analog scale at 1, 6, 12, 24, and 36 hours after the operation. The time to the first postoperative analgesic requirement and the cumulative analgesic consumption were evaluated in the three groups. Results: The visual analog scales for pain and the cumulative analgesic consumption were significantly greater in group C than in other groups. The time to first postoperative analgesic requirement was significantly shorter in group C than that in the other groups. There were no differences between group M and S for side effects. Conclusions: A relatively high dose and continuous remifentanil infusion is associated with clinically relevant evidence of acute opioid tolerance. NMDA-receptor antagonist, magnesium sulfate as an adjuvant analgesic prevents opioid tolerance in patients who are undergoing major abdominal surgery under high dose and continuous remifentanil infusion-based anesthesia.



Supported by : 원광대학교


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