Use of Magnesium in Total Hysterectomies

Postoperative Oral Magnesium for Ileus Prevention

• Oral magnesium oxide combined with disodium phosphate in fast-track hysterectomy reduces time to first defecation by approximately 1 day (n=53 randomized trial) 1, 2, 3
• The ERAS Society guidelines provide a weak recommendation (low evidence level) for incorporating oral laxatives including magnesium into a multimodal approach to optimize gut function after pelvic surgery 1, 2, 3

Intravenous Magnesium Sulfate for Perioperative Analgesia

• The 2022 ERAS Society guidelines for low-middle-income countries specifically mention magnesium among agents to consider for multimodal opioid-sparing analgesia during surgery 4

Magnesium is NOT Recommended for Preemptive Analgesia

• The 2017 Society of Gynecologic Surgeons systematic review on preemptive analgesia for hysterectomy did not identify magnesium as an effective preemptive agent 5, 6, 7, 8

Practical Implementation

• Postoperatively, initiate oral magnesium oxide combined with bisacodyl suppositories starting postoperative day 1 to accelerate return of bowel function, as recommended by the ERAS Society guidelines 1, 2, 3, 9