{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T05:02:57Z","timestamp":1781326977488,"version":"3.54.1"},"reference-count":29,"publisher":"Bentham Science Publishers Ltd.","issue":"3","content-domain":{"domain":["eurekaselect.com"],"crossmark-restriction":true},"short-container-title":["RRCT"],"published-print":{"date-parts":[[2021,7,16]]},"abstract":"<jats:sec>\n<jats:title>Background:<\/jats:title>\n<jats:p>Severe postoperative pain is principally managed by opioids. While effective,\nopioids do not provide adequate relief in many patients and cause many side effects, including\nantinociceptive tolerance and opioid-induced hyperalgesia. To evaluate if a combination of intravenous\nMagnesium, Lidocaine, Ketorolac (MLK cocktail) is a useful rescue therapy through synergistic\npharmacological mechanisms for acute pain relief. We present the intravenous combination of\nmagnesium, lidocaine, and ketorolac (MLK cocktail) as a possible rescue for opioid insensitive severe\npost-operative pain.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Materials and Methods:<\/jats:title>\n<jats:p>The principal settings were the post-operative care unit (PACU) and the\nsurgical ward. We retrospectively analyzed the electronic medical record and anesthesia documents\nof 14 patients experiencing severe postoperative pain, &gt;7\/10 visual-analogue pain score (VAS), despite\nreceiving at least 8 mg of intravenous morphine milligram equivalents (MME) after arrival in\nthe LAC+USC Medical Center PACU between September 2012 and January 2013. The data reviewed\nincluded patients\u2019 demographics, disease etiology, surgical procedure, opioids received perioperatively,\nand visual-analogue pain scores before and after each analgesic received, and after\nthe MLK cocktail. The a priori primary outcome and a posteriori secondary outcome of this study\nare mean visual-analogue pain score and morphine milligram equivalent dose administered per\nhour, respectively. The main tool evaluated has been VAS score.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results:<\/jats:title>\n<jats:p>In patients who failed to respond to opioid analgesics, administration of the MLK cocktail\nimproved the VAS pain scores immediately from 9.4 \u00b1 1.0 to 3.6 \u00b1 3.5. The MLK cocktail also decreased\nthe MME doses\/hour in the immediate 12 hours postoperative period from 12.4 \u00b1 5.6 to\n1.1 \u00b1 0.9.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions:<\/jats:title>\n<jats:p>In patients experiencing opioid-resistant severe postoperative pain, the magnesium,\nlidocaine, and ketorolac combination may be an effective nonopioid rescue therapy. Additionally,\nmagnesium, lidocaine, and ketorolac may be utilized in cases complicated by either antinociceptive\ntolerance or opioid-induced hyperalgesia and can restore opioid responsiveness.<\/jats:p>\n<\/jats:sec>","DOI":"10.2174\/1574887115666201202105620","type":"journal-article","created":{"date-parts":[[2020,12,3]],"date-time":"2020-12-03T04:22:03Z","timestamp":1606969323000},"page":"288-293","update-policy":"https:\/\/doi.org\/10.2174\/bsp_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Intravenous Magnesium \u2013 Lidocaine - Ketorolac Cocktail for Postoperative Opioid Resistant Pain: A Case Series of Novel Rescue Therapy"],"prefix":"10.2174","volume":"16","author":[{"given":"Christian","family":"Zanza","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Policlinico Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaroslava","family":"Longhitano","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Keck Medical School of University of Southern California, Los Angeles, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Keck Medical School of University of Southern California, Los Angeles, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Keck Medical School of University of Southern California, Los Angeles, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Artico","sequence":"additional","affiliation":[{"name":"Department of Sensory Organs, Sapienza University of Rome\/Policlinico Umberto I, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetta","family":"Savarese","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, St. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Bonato","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, St. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Piccioni","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Policlinico Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Franceschi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Policlinico Agostino Gemelli, Catholic University of Sacred Heart, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samanta","family":"Taurone","sequence":"additional","affiliation":[{"name":"Department of Sensory Organs, Sapienza University of Rome\/Policlinico Umberto I, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovico","family":"Abenavoli","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack Marshall","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Keck Medical School of University of Southern California, Los Angeles, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"965","reference":[{"key":"ref=1","doi-asserted-by":"publisher","first-page":"2215","DOI":"10.1016\/S0140-6736(11)60245-6","volume":"377","author":"Wu C.L.","year":"2011","unstructured":"Wu C.L.; Raja S.N.; Treatment of acute postoperative pain. 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