Clinical Efficacy of Magnesium in Perioperative Pain Management: A Narrative Review

Nov 27, 2025Current pain and headache reports

Magnesium’s effectiveness for managing pain around surgery: a review

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Circadian Biology on OpenScience ↗PubMed ↗DOI ↗

Abstract

Magnesium may reduce postoperative pain intensity and decrease opioid requirements in the first 24-48 hours after surgery.

Magnesium acts as a blocker of certain receptors and channels in the central nervous system, which reduces excitatory pain signaling.
It shows anti-inflammatory and pain-relieving properties, making it a helpful addition to pain management strategies.
Using magnesium as a preoperative or intraoperative adjunct is associated with lower pain scores among surgical patients.
Patients receiving magnesium may require fewer opioids after surgery, potentially decreasing the risk of opioid-related side effects.
Magnesium is generally well-tolerated at recommended doses, with minimal side effects such as occasional low blood pressure or mild sedation.

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PURPOSE OF REVIEW: Postoperative pain is a prevalent clinical challenge that often leads to high opioid consumption, delayed hospital discharge, and associated side effects. Inadequate pain control can delay recovery and contribute to the risk of chronic postsurgical pain and opioid dependence. Magnesium, an essential cation with diverse physiological roles, has gained attention as a non-opioid adjunct for perioperative analgesia related to multimodal mechanisms of action and a favorable profile.

RECENT FINDINGS: Pharmacologically, magnesium acts as an N-methyl-D-aspartate (NMDA) receptor antagonist and calcium channel blocker in the central nervous system, dampening excitatory neurotransmission and reducing central sensitization to pain. It also exhibits anti-inflammatory and anti-nociceptive effects and is inexpensive and easy to administer intravenously. These properties make magnesium a cost-effective and simple addition to multimodal pain management protocols. When used as a preoperative or intraoperative adjunct, magnesium has demonstrated reduced postoperative pain intensity and decreased opioid requirements across various surgical populations. Trials and meta-analyses report that patients receiving perioperative magnesium experience lower pain scores and need fewer opioids in the first 24-48 hours after surgery, translating into an opioid-sparing effect and potentially less opioid-related nausea and sedation. Importantly, magnesium has a favorable safety profile at recommended doses and generally is well-tolerated with minimal side effects apart from infrequent hypotension or mild sedation. No significant respiratory depression occurs in patients with normal renal function. The present investigation highlights magnesium-mediated analgesic mechanisms, summarizes clinical evidence for efficacy as a preoperative pain adjunct, and describes implications for improving postoperative pain outcomes and reducing opioid reliance in perioperative care.

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Clinical Efficacy of Magnesium in Perioperative Pain Management: A Narrative Review

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