Pain in the perioperative period is associated with surgical stimuli but also with
laryngoscopy and intubation. According to the currently applicable ERAS (Enhanced
Recovery After Surgery) doctrine, the recommended method of anesthesia is multimodal,
low-opioid anesthesia. The essence of multimodal anesthesia is to combine different
methods (e.g. general and regional anesthesia) and various anesthetic drugs in order to
reduce the intraoperative use of opioids. The one of commonly used co-analgetic is
magnesium. The use of magnesium infusion before induction of anesthesia may enhance the
analgesic effect of the opioid administered before intubation. In current guidelines for
the relief of acute pain in children, magnesium sulfate may be considered as a
coanalgesic. It is based only on expert consensus opinion and/or data from small studies,
retrospective studies, registries.
According to available data magnesium sulfate is superior to placebo in decreasing
analgesic consumption and pain scores during the first 48 h after operation without any
adverse effects in children with cerebral pals. In other groups of pediatric patients,
the effectiveness of magnesium as a co-analgetic has not been proven. High quality
randomized controlled trials are still missing.
The primary outcome of this study is to assess opioid consumption during the laparoscopic
appendectomy. Number of patients requiring rescue dose of opioids will be measured.
The secondary aim is to examine total intraoperative fentanyl consumption, fluctuations
of heart rate and blood pressure, metabolic, hormonal and inflammatory response (glucose,
cortisol and IL-6 concentrations) and occurrence of side effects that may result from
magnesium intake (decrease in blood pressure, bradycardia or allergic reaction).
In the pediatric population, the optimal perioperative magnesium dosage is 50 mg/kg as a
bolus followed by an infusion of 15 mg/kg/hour until the end of the operation.
The general aim of the study is to evaluate the analgesic efficacy of intravenous
magnesium sulfate as an adjunct to standard general anesthesia (involving intravenous
induction and opioid with sevoflurane maintenance) for intubation and surgical trauma
during anesthesia for laparoscopic appendectomy in children.