dexmedetomidine vs. magnesium sulfate as anesthetic adjuvants in spine surgery: effects on inflammatory response, hemodynamics, recovery, and opioid use in a randomized controlled trial

Background: non-cardiac surgery in patients with cardiovascular risk can lead to spine surgery often leads to significant postoperative pain, inflammation, and hemodynamic instability, necessitating opioid use, which increases the risk of side effects. dexmedetomidine (dex) and magnesium sulfate (mgso₄) are anesthetic adjuvants that may enhance recovery and reduce opioid consumption. this study aimed to compare the effects of dex and mgso₄ as an anesthetic adjuvant on interleukin-6 (il-6) levels, hemodynamic stability, postoperative recovery, and opioid consumption in spine surgery.methods: a randomized controlled trial was performed on 24 patients undergoing spine surgery under general anesthesia. participants were randomly divided into two groups: group 1 received dex (a 1 µg/kg bolus followed by a continuous infusion of 0.3–0.5 µg/kg/h), while group 2 was given mgso₄ (a 30–50 mg/kg bolus followed by an infusion of 10–20 mg/kg/h). hemodynamic parameters, il-6 levels (pre- and postoperatively), opioid use, and recovery outcomes were analyzed.results: il-6 levels decreased significantly in both groups (p=0.001), with a greater reduction in the dex group (-60.5 pg/dl vs. -24.9 pg/dl), though not statistically significant. hemodynamic stability was comparable, but dex provided better pulse rate control. opioid consumption was lower in the dex group at 24 and 48 hours postoperatively (p < 0.05). the dex group also showed higher aldrete scores (p<0.05) and shorter hospital stays (3.75 vs. 4.83 days, p<0.05).conclusion: dex provides superior anti-inflammatory effects, hemodynamic stability, reduced opioid use, and improved recovery compared to mgso₄ as an anesthetic adjuvant in spine surgery patients.