{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:33:24Z","timestamp":1788539604422,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Magnesium sulfate (MgSO4) has been investigated as an adjuvant in perioperative analgesia because of its antagonistic effects on the N-methyl-D-aspartate receptor (NMDA receptor) and its potential to attenuate central sensitization. However, clinical findings regarding its analgesic efficacy remain inconsistent across surgical procedures. Lumbar microdiscectomy is a common spinal procedure in which effective early postoperative pain control is important for patient comfort and early mobilization. This study aimed to evaluate the effect of intraoperative MgSO4 administration on early postoperative analgesia and perioperative outcomes in patients undergoing lumbar microdiscectomy. Methods: This retrospective single-center cohort study included thirty-eight patients with American Society of Anesthesiologists (ASA) physical status I\u2013II who underwent elective single-level lumbar microdiscectomy under general anesthesia. Patients were divided into two groups according to intraoperative magnesium administration: a control group receiving standard anesthesia without MgSO4 (n = 19) and an MgSO4 group receiving an intravenous MgSO4 bolus of 30 mg\/kg followed by a continuous infusion of 10 mg\/kg\/h until skin closure (n = 19). Postoperative pain intensity was assessed using the Numeric Rating Scale (NRS) at 0, 5, 10, 15, and 30 min after admission to the post-anesthesia care unit. Secondary outcomes included intraoperative remifentanil consumption, extubation time, and time to first mobilization. Complementary in silico analyses included molecular docking and protein\u2013protein interaction (PPI) network analysis. Results: Postoperative NRS scores were numerically lower in the MgSO4 group; however, between-group differences were not statistically significant. Mean intraoperative remifentanil consumption was numerically lower in the MgSO4 group (236 \u00b1 166 \u00b5g) compared with the control group (319 \u00b1 298 \u00b5g), without statistical significance (p = 0.27). Repeated-measures analysis demonstrated the significant effect of time on postoperative NRS scores, whereas the overall group effect was not significant. Molecular analyses indicated stable morphine binding to opioid receptors and highlighted glutamatergic signaling components as central nodes within the interaction network. Conclusions: Intraoperative MgSO4 administration was not associated with significant improvements in early postoperative pain scores or perioperative recovery parameters following lumbar microdiscectomy. Molecular analyses provide exploratory in silico insights and should be interpreted cautiously given the retrospective design and the in silico nature of these findings.<\/jats:p>","DOI":"10.3390\/jcm15082888","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T10:20:16Z","timestamp":1775816416000},"page":"2888","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Intraoperative Magnesium Sulfate and Early Postoperative Analgesia in Lumbar Microdiscectomy: A Retrospective Clinical Study Integrating Molecular Docking and Protein Interaction Network Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0526-1459","authenticated-orcid":false,"given":"Tamer","family":"Tamdogan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Giresun University Faculty of Medicine, Giresun 28200, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ersin","family":"Guner","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Konya Numune Hospital, Ministry of Health of the Republic of T\u00fcrkiye, Konya 42060, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilke","family":"Tamdogan","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Reanimation, Giresun University Faculty of Medicine, Giresun 28200, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sevim","family":"Ondul","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Giresun University Faculty of Medicine, Giresun 28200, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muharrem Furkan","family":"Yuzbasi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras 46040, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2003-6337","authenticated-orcid":false,"given":"Ibrahim","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Unit of Pharmacovigilance, Doctor Ismail Fehmi Cumalioglu City Hospital, Ministry of Health of the Republic of T\u00fcrkiye, Tekirdag 59020, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8084-7855","authenticated-orcid":false,"given":"Hanefi","family":"Ozbek","sequence":"additional","affiliation":[{"name":"Department of Medical Pharmacology, Usak University Faculty of Medicine, Usak 64000, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1241","DOI":"10.1097\/PR9.0000000000001241","article-title":"A 5000-year overview of the history of pain through ancient civilizations to modern pain theories","volume":"10","author":"Vincenot","year":"2025","journal-title":"Pain Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1038\/s41392-024-01845-w","article-title":"Pathology of pain and its implications for therapeutic interventions","volume":"9","author":"Cao","year":"2024","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.jatmed.2025.09.001","article-title":"Clinical practice guidelines for postoperative pain management in adults (2024 edition)","volume":"4","author":"Chen","year":"2025","journal-title":"J. Anesth. Transl. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Fuller, A.M., Bharde, S., and Sikandar, S. (2023). The mechanisms and management of persistent postsurgical pain. Front. Pain Res., 4.","DOI":"10.3389\/fpain.2023.1154597"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Podder, D., Stala, O., Hirani, R., Karp, A.M., and Etienne, M. (2025). Comprehensive approaches to pain management in postoperative spinal surgery patients: Advanced strategies and future directions. Neurol. Int., 17.","DOI":"10.3390\/neurolint17060094"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.wneu.2021.02.040","article-title":"Multimodal analgesia in spine surgery: An umbrella review","volume":"149","author":"Ntalouka","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S160","DOI":"10.21037\/jss.2019.09.33","article-title":"Anesthesia and postoperative pain control\u2014Multimodal anesthesia protocol","volume":"5","author":"Bhatia","year":"2019","journal-title":"J. Spine Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1093\/bja\/aei291","article-title":"Effects of three different dose regimens of magnesium on propofol requirements, haemodynamic variables and postoperative pain relief in gynaecological surgery","volume":"96","author":"Seyhan","year":"2006","journal-title":"Br. J. Anaesth."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s42077-021-00210-1","article-title":"Magnesium sulphate within multimodal analgesia, pre-emptive, or preventive analgesia","volume":"14","author":"Kamel","year":"2022","journal-title":"Ain-Shams J. Anesthesiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1111\/j.1365-2044.2012.07335.x","article-title":"Peri-operative intravenous administration of magnesium sulphate and postoperative pain: A meta-analysis","volume":"68","author":"Albrecht","year":"2013","journal-title":"Anaesthesia"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1097\/ALN.0b013e318297630d","article-title":"Perioperative systemic magnesium to minimize postoperative pain: A meta-analysis of randomized controlled trials","volume":"119","author":"Khan","year":"2013","journal-title":"Anesthesiology"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Wu, E.B., Wu, K.L., Hsu, W.T., Yuan, W.C., and Chen, K.B. (2025). Pharmacological efficacy of intravenous magnesium in attenuating remifentanil-induced postoperative hyperalgesia: A systematic review and meta-analysis of randomized controlled trials. Pharmaceutics, 18.","DOI":"10.3390\/ph18040518"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1097\/EJA.0000000000001003","article-title":"Effect of pretreatment with magnesium sulphate on the duration of intense and deep neuromuscular blockade with rocuronium: A randomized controlled trial","volume":"36","author":"Filho","year":"2019","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3000605211027736","DOI":"10.1177\/03000605211027736","article-title":"Efficacy of magnesium sulfate as an adjuvant to rocuronium in general anaesthesia: A meta-analysis","volume":"49","author":"Sun","year":"2021","journal-title":"J. Int. Med. Res."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"F\u00e1bi\u00e1n, \u00c1.I., Csernoch, V., Tassonyi, E., Fedor, M., and F\u00fclesdi, B. (2019). The effect of magnesium on the reversal of rocuronium-induced neuromuscular block with sugammadex: An ex vivo laboratory study. BMC Anesthesiol., 19.","DOI":"10.1186\/s12871-019-0734-6"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"5337483","DOI":"10.1155\/2022\/5337483","article-title":"VAS and NRS, same or different? Are visual analog scale values and numerical rating scale equally viable tools for assessing patients after microdiscectomy?","volume":"2022","author":"Bielewicz","year":"2022","journal-title":"Pain Res. Manag."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4361","DOI":"10.1016\/j.cell.2022.09.041","article-title":"Molecular recognition of morphine and fentanyl by the human \u03bc-opioid receptor","volume":"185","author":"Zhuang","year":"2022","journal-title":"Cell"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"eaax9115","DOI":"10.1126\/sciadv.aax9115","article-title":"Elucidating the active \u03b4-opioid receptor crystal structure with peptide and small-molecule agonists","volume":"5","author":"Claff","year":"2019","journal-title":"Sci. Adv."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1038\/s41467-020-14889-7","article-title":"Nanobody-enabled monitoring of kappa opioid receptor states","volume":"11","author":"Che","year":"2020","journal-title":"Nat. Commun."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.neuron.2025.01.021","article-title":"Structural insights into the diverse actions of magnesium on NMDA receptors","volume":"113","author":"Huang","year":"2025","journal-title":"Neuron"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"D638","DOI":"10.1093\/nar\/gkac1000","article-title":"The STRING database in 2023: Protein\u2013protein association networks and functional enrichment analyses for any sequenced genome","volume":"51","author":"Szklarczyk","year":"2023","journal-title":"Nucleic Acids Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2498","DOI":"10.1101\/gr.1239303","article-title":"Cytoscape: A software environment for integrated models of biomolecular interaction networks","volume":"13","author":"Shannon","year":"2003","journal-title":"Genome Res."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Chin, C.H., Chen, S.H., Wu, H.H., Ho, C.W., Ko, M.T., and Lin, C.Y. (2014). cytoHubba: Identifying hub objects and sub-networks from complex interactome. BMC Systems Biol., 8.","DOI":"10.1186\/1752-0509-8-S4-S11"},{"key":"ref_25","first-page":"e56348","article-title":"Magnesium sulfate and its versatility in anesthesia: A comprehensive review","volume":"16","author":"Dahake","year":"2024","journal-title":"Cureus"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Sohn, H.M., Kim, B.Y., Bae, Y.K., Seo, W.S., and Jeon, Y.T. (2021). Magnesium sulfate enables patient immobilization during moderate block and ameliorates the pain and analgesic requirements in spine surgery, which cannot be achieved with opioid-only protocol: A randomized double-blind placebo-controlled study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10194289"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"280","DOI":"10.17085\/apm.22156","article-title":"Effect of intravenous magnesium on postoperative pain control for major abdominal surgery: A randomized double-blinded study","volume":"17","author":"Yazdi","year":"2022","journal-title":"Anesth. Pain Med."},{"key":"ref_28","first-page":"844524","article-title":"Unravelling the analgesic effects of perioperative magnesium in general abdominal surgery: A systematic review and meta-analysis of randomized controlled trials","volume":"74","author":"Avci","year":"2024","journal-title":"Braz. J. Anesthesiol."},{"key":"ref_29","first-page":"e12750","article-title":"Magnesium can decrease postoperative physiological ileus and postoperative pain in major non-laparoscopic gastrointestinal surgeries: A randomized controlled trial","volume":"4","author":"Motalebi","year":"2013","journal-title":"Anesth. Pain Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1097\/00000542-199602000-00011","article-title":"Role of magnesium sulfate in postoperative analgesia","volume":"84","author":"Tramer","year":"1996","journal-title":"Anesthesiology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1111\/j.1399-6576.1997.tb04830.x","article-title":"Perioperative magnesium infusion and postoperative pain","volume":"41","year":"1997","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_32","first-page":"e626","article-title":"The effect of intravenous magnesium sulfate on post-operative analgesia during laminectomy","volume":"8","author":"Ghaffaripour","year":"2016","journal-title":"Cureus"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/2888\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T10:48:31Z","timestamp":1775818111000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/2888"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,10]]},"references-count":32,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15082888"],"URL":"https:\/\/doi.org\/10.3390\/jcm15082888","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,10]]}}}