Intraperitoneal Magnesium Sulphate and Bupivacaine Versus Intravenous Analgesia in Laparoscopic Surgeries in Pediatrics
Condition: Intraperitoneal Magnesium Sulphate in Laparoscope in Pediatrics
Study type: Interventional
Phase: Phase 4

Summary: 
      The investigators are going to study the analgesic efficacy of intraperitoneal instillation
      of a combination of Magnesium sulphate with bupivacaine versus ordinary used parenteral
      analgesics for pain relief after laparoscopic surgeries in pediatrics.
    

Detailed description: 
      Laparoscopic surgery is a modern surgical technique used for various surgeries such as
      cholecystectomy, appendectomy and hernia repair. There are a number of advantages of this
      technique including reduced pain and bleeding, shorter recovery time and hospital stay, and
      over all reduced healthcare costs. The type of pain after laparoscopic surgery differs
      considerably from that occurs after laparotomy. Usually patients experience diffuse pain in
      abdomen, back and shoulder. Acute pain after laparoscopic cholecystectomy has three different
      components: incisional pain (somatic pain), visceral pain (deep intra-abdominal pain), and
      shoulder pain (presumably referred visceral pain) . Postoperative nausea and vomiting is a
      commonly observed phenomenon after laparoscopic procedures. Its incidence increases depending
      on the anesthetic techniques used. Pain intensity usually peaks during the first
      postoperative period and usually declines over the following 2-3 days. Pain can prolong
      hospital stay and lead to increased morbidity.

      Inadequately treated pain may lead to splinting, loss of sighing and decrease in vital
      capacity, and these may contribute to postoperative pulmonary morbidity. Various multimodal
      approaches have, therefore, been tried to ameliorate postoperative pain. These include
      parenteral analgesics, local infiltration with local anesthetics, epidural and intrathecal
      opioids and local anesthetics, interpleural and intercostals nerve blocks as well as
      intraperitoneal routes that in turn has been explored with local anesthetics and opioids . In
      order to get an instant relief, polypharmacy is commonly practiced which can be potentially
      harmful to the patient and can lead to re-admission. It has been appreciated that multiple
      glutamate receptors are expressed on peripheral nerve terminals, and these may contribute to
      peripheral nociceptive sensation .

      Administration of magnesium sulphate via different routes has been used in anaesthetic
      practice for decreasing perioperative pain. Parenteral magnesium sulphate has been used for
      many years as an antiarrhythmic agent and for seizure prophylaxis in eclampsia and
      preeclampsia. It is N-methyl d-aspartate (NMDA) receptor antagonist and suppresses these
      receptor induced inflammation and hyper responsiveness . The antinociceptive effect of
      magnesium sulphate is not only useful in chronic pain, but it also determines in part, the
      duration and intensity of postoperative pain . These effects are due to calcium antagonism
      and decrease influx of calcium into the cell and antagonism of NMDA receptor. As these
      receptors regulate neuronal signalling and are involved in pain processing, magnesium
      sulphate by blocking this receptor, decreases postoperative pain as well .
    

Intervention name(s): Magnesium Sulfate & bupivacaine; paracetamol & ketorolac
Intervention type(s): Drug; Drug
Intervention description(s): intraperitoneal instillation of a combination of Magnesium sulphate with bupivacaine; parenteral analgesics
Intervention MeSH terms: Acetaminophen; Ketorolac; Magnesium Sulfate; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Treatment
Keywords: intraperitoneal, laparoscopic surgeries, pediatrics