Elevated Lidocaine Serum Concentration After Subcutaneous Lidocaine Administration Using a Needle-Free Device in Pediatric Patients

Gulur, Padma; Cohen, Alma; Watt, Lisa; Lau, Mary E; Saleeby, Chadi El

doi:10.1097/pec.0000000000000178

Cited by 8 publications

(6 citation statements)

References 3 publications

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“…A recently published case series reported on 4 children with elevated serum lidocaine levels after J tip lidocaine administration. 15 Though the clinical significance of this is unknown, this study did not evaluated for toxic lidocaine levels in children and this may have been unrecognized. However, based on direct observation of the children immediately after the administration of the J tip, no children showed clinical signs of lidocaine toxicity including dizziness, disorientation, seizures, chest pain or difficulty breathing.…”

Section: Resultsmentioning

confidence: 97%

A Randomized Clinical Trial of Jet-Injected Lidocaine to Reduce Venipuncture Pain for Young Children

Lunoe

Drendel

Levas

et al. 2015

Annals of Emergency Medicine

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Background The J tip uses air instead of a needle to push lidocaine into the skin. No studies have investigated its use for venipuncture in young children. Objective Determine if J tip decreased venipuncture pain in young children compared to vapocoolant spray. Methods Children ages 1 to 6 years were randomized into 3 groups: Intervention – J tip, Control –vapocoolant spray, and Sham –vapocoolant spray and “pop” of an empty J tip. The procedure was videotaped and scored using the FLACC tool at three times; Baseline - before approach, Device - J tip deployment and Venipuncture - venipuncture. The FLACC tool was scored 0(none) to 10(severe). Comparisons of pain scores over time were made using the Generalized Estimating Equation. Venipuncture success and adverse effects were assessed and compared using Χ2. Results 205 children enrolled; Intervention=96, Control=53, Sham=56. There were no between group differences in baseline characteristics. There was no mean change in pain scores from Device to Venipuncture in the Intervention group (0.25, 95% CI (−0.31, 0.82) but there was an increase in pain in the Control (2.82, 95% CI (1.91, 3.74) and Sham (1.68, 95% CI (0.83, 2.52) groups. This change was greater for the Control and Sham compared to the Intervention group. There was no difference in venipuncture success between groups. No severe adverse events occurred. Minor adverse events were the same between groups. Conclusion Use of the J tip for children ages 1 to 6 years reduced venipuncture pain compared to vapocoolant spray or sham treatment.

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Section: Resultsmentioning

confidence: 97%

A Randomized Clinical Trial of Jet-Injected Lidocaine to Reduce Venipuncture Pain for Young Children

Lunoe

Drendel

Levas

et al. 2015

Annals of Emergency Medicine

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“…When lidocaine is used as an antiarrhythmic drug, goal blood therapeutic levels range between 1.5 and 5 mcg/ml. Adverse effects have been reported in literature with therapeutic lidocaine blood levels, especially in patients under three years of age [ 21 – 23 ]. The two patients that presented neurological symptoms were infants and had the highest blood lidocaine levels in our series (over 2 mcg/ml).…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, we consider it important to monitor neurological status closely and to determine blood lidocaine levels within the first 24 hours of treatment to promptly detect patients at risk of high systemic absorption and, therefore, avoid toxicity. If neurologic manifestations appear and no other explanation is found, lidocaine toxicity must be suspected, and infusion must be stopped even if blood levels were not in the toxic range, especially in the younger patients [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

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Continuous Incisional Lidocaine in Pediatric Patients following Open Heart Surgery

Fernández

Toledo

Cebrían

et al. 2022

BioMed Research International

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Continuous incisional lidocaine infusion has been proposed as an adjunctive therapy in the management of postoperative pain in adult patients. The aim of this study was to determine the efficacy and safety of a continuous subcutaneous lidocaine infusion in pediatric patients following open heart surgery. All patients receiving a subcutaneous lidocaine infusion in median sternotomy incisions after open heart surgery during 2 consecutive years were included in the study. A historical cohort of patients was used as a control group. Demographic variables (age, size, and surgical procedure), variables related to sedation and analgesia (COMFORT and analgesia scales, drug doses, and duration), and complications were registered. 106 patients in the lidocaine infusion group and 79 patients in the control group were included. Incisional analgesia was effective for the treatment of pain as it reduced the dose and duration of intravenous fentanyl (odds ratio (OR) 6.26, confidence interval (CI) 95%: 2.48-15.97, p = 0.001 ; OR 4.30, CI 95%: 2.09-8.84, p = 0.001 , respectively). The reduction in fentanyl use was more important in children over two years of age. Adverse effects were seen in three children (2.8%): they all had decreased level of consciousness, and one of them presented seizures as well. Two of these three patients had lidocaine levels over 2 mcg/ml. A continuous lidocaine incisional infusion is effective for the treatment of pain after open heart surgery. This procedure reduced intravenous analgesic drug requirements in pediatric patients undergoing a median sternotomy incision. Although the incidence of secondary effects is low, monitoring of neurologic status and lidocaine blood levels are recommended in all patients.

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“…Adverse events appear minimal. Elevated lidocaine serum concentrations after use have been found in children, however, clinical relevance is unknown 81 …”

Section: On the Horizonmentioning

confidence: 99%

Optimizing pediatric periprocedural pain management part II—Adjunct therapies to support the use of infiltrative anesthetics

Henkel,

Haller,

Diaz

et al. 2024

Pediatric Dermatology

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Pediatric procedure‐related pain management is often incompletely understood, inadequately addressed, and critical in influencing a child's lifelong relationship with the larger healthcare community. We present a comprehensive review of infiltrative anesthetics, including a comparison of their mechanisms of action and relative safety and efficacy data to help guide clinical selection. We also describe the multimodal utilization of adjunct therapies—in series and in parallel—to support the optimization of pediatric periprocedural pain management, enhance the patient experience, and provide alternatives to sedation medication and general anesthesia.

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Elevated Lidocaine Serum Concentration After Subcutaneous Lidocaine Administration Using a Needle-Free Device in Pediatric Patients

Cited by 8 publications

References 3 publications

A Randomized Clinical Trial of Jet-Injected Lidocaine to Reduce Venipuncture Pain for Young Children

A Randomized Clinical Trial of Jet-Injected Lidocaine to Reduce Venipuncture Pain for Young Children

Continuous Incisional Lidocaine in Pediatric Patients following Open Heart Surgery

Optimizing pediatric periprocedural pain management part II—Adjunct therapies to support the use of infiltrative anesthetics

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