Does Perioperative Intravenous Magnesium Affect Postoperative Quality of Recovery in Craniotomy Surgery Patients?

Study Overview
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Brief Summary
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Perioperative pain management for craniotomy patients may be challenging because the commonly used agents such as opioids, gabapentin, and dexmedetomidine also cause sedation, which can confound the neurological exam and can lead to respiratory depression and increased intracranial pressure. Preoperative intravenous magnesium boluses and infusions have previously been established as an effective, nonsedating analgesic that can reduce opioid consumption 25-30% up to 48 hours postoperatively. However, intravenous magnesium has not seen widespread use in craniotomy patients due to concerns for interference with the neurological monitoring that commonly occurs in these cases. Intravenous magnesium given as a bolus preoperatively or as a constant infusion may avoid these problems and has never been investigated. The goal of this study is to compare intravenous magnesium given preoperatively and intraoperatively to placebo in adult elective craniotomy patients to improve quality of recovery postoperatively, and evaluate safety and tolerability. Secondary endpoints will include evaluating for pain, sedation, agitation, blood pressure, and opioid consumption postoperatively.

Detailed Description
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The study is a prospective, randomized, controlled, and double-blinded clinical trial comparing clinical outcomes of craniotomy patients who a magnesium infusion of 15mg/kg/hr to a placebo group of patients who will receive a saline bolus and infusion of equivalent volume starting at surgical closure and continuing for 15 hours. The sample size calculations are based on an effect size 24 point increase in Quality of Recovery-40 Questionnaire scores from a previous randomized control trial featuring the same bolus and infusion regimen as this trial. Investigators, patients, and providers will be blinded. Patients over the age of 18 undergoing elective craniotomy surgery will be enrolled. The study population will consist of patients undergoing elective craniotomy surgery. The inclusion criteria consists of patient age 18-85, ASA (American Society of Anesthesiologists) Physical Status Classification 1-3, with Glasgow Coma Scale (GCS) of 15 with adequate english comprehension. Exclusion criteria includes pregnant or nursing patients, patients with known allergies to any of the study drugs, patient's refusal, patients with a history of cirrhosis, chronic kidney disease stage 3 or higher, known history of substance abuse, neuromuscular disease or heart block.

Official Title
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Does Perioperative Intravenous Magnesium Affect Postoperative Quality of Recovery in Elective Craniotomy Surgery Patients?

Conditions
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Brain Tumor, Surgery

Intervention / Treatment
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* Drug: IV magnesium sulfate
* Other: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patient age 18-85 ASA (American Society of Anesthesiologists) Physical Status Classification 1-3 Glasgow Coma Scale (GCS) of 15 Adequate english comprehension Exclusion Criteria: pregnant or nursing patients patients with known allergies to any of the study drugs patient's refusal patients with a history of cirrhosis chronic kidney disease stage 3 or higher known history of substance abuse history of neuromuscular disease history of heart block

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Control<br>The control arm will receive an equivalent volume of normal saline as the treatment group | Other: Placebo<br>* 500 cc normal saline delivered in equivalent rates as the treatment group<br>|
| Experimental: IV magnesium<br>We will randomize patients in the treatment group to receive either a 50 mg/kg bolus of intravenous magnesium preoperatively followed by a magnesium infusion of 15mg/kg/hr, to be given after intraoperative neuromonitoring staff have been able to record baseline neurological data. | Drug: IV magnesium sulfate<br>* 15 grams magnesium in 500 cc normal saline delivered at a rate of 15 mg/kg/hr<br>* Other names: Magnesium Sulfate IV;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of Recovery Questionnaire 40 | Validated measure of postoperative quality of recovery | Postoperative days 0-2 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hypertension Postoperative | systolic blood pressure > 160 | postoperative days 0-2 | 
| Postoperative Hyperglycemia | glucose > 180 | Postoperative days 0-2 | 
| Complications Possibly Related to Intraoperative Neuromonitoring | We will monitor for rates of complications postoperatively, noting whether or not they could have been detected by intraoperative neuromonitoring | postoperative days 0-2 | 
| Shivering | Bedside Shivering Scale | First 2 hours in the postoperative care unit or intensive care unit |