MAG-PAIN - MAGnesium for Postoperative Analgesia In the Newly Delivered

The study aims to investigate whether a commonly used medicine, magnesium, can help reduce pain after a Caesarean section. A total of 150 participants will be included. Their usual medical care will not change, and participation is entirely voluntary. The purpose of the study is to determine whether magnesium can improve pain relief after surgery and support faster recovery and bonding with the newborn. Before the operation, potential participants will receive a text message containing a short questionnaire about their background and their expectations regarding postoperative pain. On the day of surgery, all patients will receive two intravenous lines as part of routine care. Those who participate in the study will be asked to rate how painful this insertion was on a scale from one to ten. The participants will then be randomly assigned to receive either magnesium or a saltwater solution through a 100 ml drip, which is administered after the baby is born. Neither participants nor the clinical staff will know which solution has been given, and no blood samples will be collected. After the procedure, participants will be asked several times about their pain level. During the first three days after the operation, each participant will receive one text message per day with a short questionnaire about their pain, general recovery, and early bonding with their newborn. Fourteen days after the operation, and again three months later, they will receive additional questionnaires similar to the earlier ones. Each questionnaire takes approximately five to seven minutes to complete, and no extra hospital visits are required. Magnesium can cause side effects, but the risks associated with the dose used in the study are low. The most common side effect is a brief burning sensation at the infusion site, which is not harmful. Magnesium is widely used in medical care, including in pregnant patients, and the study team considers the treatment safe. Because the medication is administered after birth, it does not affect the baby and does not increase risks during breastfeeding. All collected information will be handled securely and confidentially. Data will be coded so that individual participants cannot be directly identified, and only the research team will have access to the key linking codes to individuals. Participants have the right to access their data, request corrections, ask for deletion of their information, or limit how their data is used. The study has been approved by the Swedish Ethical Review Authority, and results will be published in a scientific journal without identifying any participant. No financial compensation is provided, but participants are covered by the usual patient and medication insurance. To ensure that the study is conducted correctly, authorized monitors or authorities may compare study data with medical records. These individuals must sign confidentiality agreements. By giving consent to participate, individuals allow this review. All data will be stored according to legal archiving requirements. Participation in the study is completely voluntary. Individuals may withdraw at any time, and if they do, their collected data will be deleted. Their medical care before, during, and after the operation will not be affected by their decision to participate or withdraw.

Background: Caesarean section is one of the most common surgical procedures worldwide, and the number performed continues to rise. Even with improvements in surgery and modern perioperative care, managing pain after a Caesarean section remains a major challenge. Severe postoperative pain can slow a mother's recovery and make it harder to bond with her baby or begin breastfeeding. Good pain control is important not only for comfort but also to prevent complications such as delayed movement, blood clots, and breathing problems. Post-Caesarean pain has many possible causes, involving both tissue-related (nociceptive) and nerve-related (neuropathic) components, which means pain management often needs to be tailored to each individual. Magnesium has been used in obstetrics for many years because of its medical benefits. It is commonly given to prevent or treat eclamptic seizures and to protect premature babies from brain injury. It can also stabilise blood pressure in pregnancy-related hypertension. Although its exact pain-relieving mechanism is not fully understood, magnesium is believed to reduce pain by influencing calcium movement in cells and by blocking NMDA receptors, which play a role in pain signalling. Some studies suggest that magnesium may help reduce pain after surgery. However, there are currently no official recommendations for its use specifically during Caesarean sections. This study aims to determine whether giving magnesium intravenously during planned Caesarean sections can improve postoperative pain and recovery. The study also examines whether magnesium leads to reduced opioid use and lower rates of nausea and vomiting after surgery. The researchers hypothesise that magnesium will be superior to standard care for both the primary and secondary outcomes. Study design: The MAG-PAIN trial is a double-blinded, randomized controlled study, meaning that participants are randomly placed into one of two groups, and neither they nor the medical staff know which treatment they receive. Inklusion and exclusion criteria: To take part, participants must be over 18, able to understand Swedish, and scheduled for an elective Caesarean section under spinal anaesthesia. People with advanced kidney disease, planned general anaesthesia, preeclampsia already treated with magnesium, or myasthenia gravis cannot join. All participants must give written and verbal consent and are free to withdraw at any time. Methods: Participants are informed about the study during their preoperative consultation and, if they agree to join, they complete a baseline form about their health and medical history. Participants are also assessed by an anaesthesiologist one to three days before surgery as part of routine care. On the day of surgery, a midwife places an IV line and records details such as needle size and any pain from insertion. A trained anaesthesia nurse, who is not clinically involved, performs randomization and prepares the study medication, ensur trial.show_full_description

Inclusion Criteria: * Adult * Planned or non-urgent c-section in regional anesthesia * Ability to read, speak and understand infromation in Swedish * Oral and written consent Exclusion Criteria: * Contraindications for spinal anesthesia * Moderate to severe kidney failure * Need of translator * Ongoing treatment with magnesium-infusion * Myastenia Gravis