Abstract

Background: Postoperative pain following tonsillectomy remains a major clinical challenge, particularly in pediatric patients. Magnesium, an essential electrolyte with neuromodulatory properties, has been suggested to exert analgesic effects through inhibition of N-methyl-D-aspartate (NMDA) receptors and modulation of central sensitization. However, its clinical effectiveness in tonsillectomy-related pain has not been systematically evaluated.
Objective: To systematically review clinical studies investigating the effect of magnesium administration on postoperative pain and analgesic consumption following tonsillectomy or adenotonsillectomy.
Materials and methods: A systematic literature search was conducted in PubMed/MEDLINE, Embase, and Cochrane CENTRAL from database inception to the date of last search. Controlled clinical studies evaluating perioperative or postoperative magnesium administration in tonsillectomy patients were included. Outcomes of interest were postoperative pain intensity and analgesic consumption. Study selection followed PRISMA 2020 guidelines. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.
Results: Eleven studies were included in the qualitative synthesis, most of which were randomized controlled trials conducted in pediatric populations. Magnesium was administered via different routes, including intravenous, topical, and local peritonsillar application. Several studies reported reduced postoperative pain scores and/or decreased analgesic requirements in patients receiving magnesium, including a recent double-blind randomized trial demonstrating significant analgesic benefits following local peritonsillar magnesium administration. Overall risk of bias was judged as low to moderate, with common limitations including small sample sizes and incomplete reporting of randomization procedures.
Conclusion: Current evidence suggests that magnesium may provide a modest, additive analgesic benefit following tonsillectomy, particularly as part of a multimodal analgesic regimen. Local application of magnesium may represent a promising approach; however, due to clinical and methodological heterogeneity, further well-designed randomized controlled trials are required to define optimal dosing, timing, and routes of administration.

Author Details

Authors

• Jens Büntzel^{1, 5}
• Sören Klaus Büntzel²
• Klaus Kisters^{3, 5}
• Oliver Micke^{4, 5}

Departments

• ¹ Department of Otolaryngology, Südharz Klinikum Nordhausen, Nordhausen,
• ² Department of Radiotherapy, Special Oncology, Medical School Hannover, Hanover,
• ³ operasan dialysis center Herne, Herne,
• ⁴ Department of Radiotherapy, Franziskus Hospital Bielefeld, Bielefeld, and
• ⁵ German Society for Magnesium Research, Germany

Address

Prof. Dr. med. Jens Büntzel
Klinik für HNO-Erkrankungen, Kopf-Hals-Chirurgie
Südharz Klinikum Nordhausen gGmbH
Dr.-Robert-Koch-Str. 39
99734 Nordhausen, Germany
Email: [email protected]

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