Effect of Adding Magnesium Sulphate to Pediatric Caudal Bupivacaine on Hemodynamics Parameters and Surgical Stress: Randomized Double-Blind Control Study

Abstract

Background: Caudal anesthesia/analgesia is simple to perform, reliable and safe. Various adjuvants have been utilized with local anesthetic to prolong duration of post-operative analgesia of caudal block in pediatric patients, but with variable results. Aim and Objective: This study is conducted to evaluate the hemodynamics effects and surgical stress response of caudal magnesium sulfate with bupivacaine in children undergoing lower abdominal surgeries. Methods: The study was approved by the local ethics committee, and a written consent was obtained for each subject, and included 60 children ASA classification I and II, aged 1 year to 6 years scheduled for lower abdominal surgeries randomized into one of two groups. after inhalation induction of general anesthesia, standard caudal block was done the participants were randomized into one of two groups either receive 1ml volume containing 50mg of magnesium sulfate (group Mg) added to 1ml /kg bupivacaine 0.25% or 1ml saline as placebo added to the same dose of bupivacaine in group (C). Postoperative pain assessed by FLACC score (acronym for Face, Legs, Activity, Cry and CONSOL ability) and duration of analgesia, postoperative sedation as well as hemodynamic parameters were compared between the two groups. Results: Group Mg had significantly lower FLACC score than group C in the first six postoperative hours. The sedation score was significantly higher only during the first postoperative hours in group Mg compared to group C. There was no statistically significant difference between groups about hemodynamic parameters at any time during the study period. Conclusion: Caudal magnesium sulfate 50mg enhance caudal block and prolongs duration of analgesia with bupivacaine in pediatric patient undergoing lower abdominal surgeries under general anesthesia with minimum adverse effects.

Effect of magnesium added to local anesthetics for caudal anesthesia on postoperative pain in pediatric surgical patients: A systematic review and meta-analysis with Trial Sequential Analysis

“…In all trials, participants were predominantly male. The dose of magnesium administered in all of the six trials was 50 mg. Bupivacaine was used for caudal anesthesia in one trial [ 17 ] and ropivacaine was used in the rest of the studies. The dose and concentration of ropivacaine varied among the studies.…”

“…Askar et al reported that FLACC scores were better in the magnesium group at 2, 4, and 6 h after surgery than in the control group. [ 17 ] Sridhar et al reported that the Modified Objective Pain Score was significantly better at 6 h and 12 h after surgery in the magnesium group [ 16 ]. The pain scores were similar in the other two trials.…”

“…Sedation was assessed in four trials, and there was no significant difference between the treatment groups in three trials [ 16 , 18 , 19 ]. Askar et al reported that the Ramsay Sedation Score was slightly higher in the magnesium group after 30 and 60 min [ 17 ]. Respiratory depression was evaluated in two trials but not found in either of the treatment groups [ 18 , 21 ].…”

“…Respiratory depression was evaluated in two trials but not found in either of the treatment groups [ 18 , 21 ]. Blood pressure and heart rate were recorded in three trials, and found to be comparable between the groups in two trials [ 16 , 19 ]; in one trial they were slightly lower in the magnesium group for 30 min after admission to the PACU [ 17 ]. Time to first micturition was evaluated in two studies and found to be comparable between groups [ 20 , 21 ].…”

Transversus Abdominal Plane Block

“…Asker et al 17 evaluated the effects of coadministration of 50 mg MgSO4 with 0.25% bupivacaine on hemodynamic parameters and pain score of study patients undergoing caudal block for lower abdominal surgeries concluded that addition of magnesium enhances the analgesic efficacy of caudal block and reduces the need of rescue analgesia and has minimum effects on hemodynamics. In our study, we also did not found any significant adverse effect of coadministration of magnesium on hemodynamic parameters.…”