Comparison of Analgesic Effect of Magnesium Added to Ropivacaine and Ropivacaine Alone in Caudal Analgesia on Postoperative Pain Control in Pediatric Patients Undergoing Inguinal Hernia Repair
Condition: Inguinal Hernia
MeSH terms: Hernia; Hernia, Inguinal
Study type: Interventional

Summary: 
      A caudal anesthesia is one of the most commonly used technique providing intra and
      postoperative analgesia in pediatric low abdominal surgery. The practice of adding adjunct
      analgesic drugs to local anesthetics for caudal block is common. The most commonly used drugs
      are opioids, clonidine, and ketamine. However, their use has been limited by adverse effects
      in children.

      Recently, the importance of magnesium in analgesic effects has been increased. Magnesium is
      the fourth most abundant cation in the body. It has antinociceptive effects in human and
      these effects are primarily based on the regulation of calcium influx into the cell.
      Magnesium is a physiological calcium antagonist and blocks N-methyl-D-aspartate (NMDA)
      receptor and such NMDA antagonism prevents the central sensitization from nociceptive
      stimulation. Many study suggested that epidurally administered magnesium could reduce the
      postoperative pain in adults. But few studies are available about the use of magnesium in
      pediatrics.

      The investigators performed prospective randomized double-blind study to examine the
      analgesic effect of magnesium added to ropivacaine and ropivacaine alone in caudal analgesia
      on postoperative pain control in pediatric patients undergoing inguinal hernia repair.

      80 children (aged 2- 6 yr) undergoing inguinal hernia repair were included in this
      prospective, randomized, double-blinded study. After inhalation induction of general
      anesthesia, caudal block was applied. Patients were randomly assigned in two groups. Normal
      saline 0.5mL added to ropivacaine 0.15% 1.0 ml/kg was administered to Group R , Magnesium
      50mg (Magnesium 10% 0.5mL)added to ropivacaine 0.15% 1.0ml/kg to Group MR. Postoperative pain
      was recorded at 30min and 1,2,3 h by using Hospital of Eastern Ontario Pain Scale (CHEOPS,
      0-10) and Faces Legs Activity Cry Consolability tool (FLACC, 0-10). Participants will be
      followed for the duration of hospital stay, an expected average of 3 hours.

      After discharge, rescue analgesic consumption, pain scores (Parents Postoperative Pain
      Measurement, PPPM), and adverse effects were evaluated for 48h.

      The time to first supplemental oral analgesic medication demand was defined as the time from
      the end of surgery to the first registration of a PPPM( 0 - 15) ≥ 6 by parent's observation.
      48 hours after surgery, reports of delayed side effects and demands for rescue analgesics
      from the child were gathered from parents via a telephone interview.
    


Intervention name(s): caudal block; normal saline 0.5ml
Intervention type(s): Drug; Drug
Intervention description(s): After inhalation induction of general anesthesia, caudal block was applied. Patients were randomly assigned in two groups. Normal saline 0.5mL added to ropivacaine 0.15% 1.0 ml/kg was administered to Group R , Magnesium 50mg (Magnesium 10% 0.5mL)added to ropivacaine 0.15% 1.0ml/kg to Group MR.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: inguinal hernia, caudal analgesia, magnesium