Perioperative intravenous lidocaine use in children

Abstract

Inflammation, tissue injury, and nerve injury all contribute to postoperative pain mechanisms. 1 Opioids are efficacious but many patients suffer from side effects including postoperative nausea and vomiting (PONV) and respiratory depression. [1][2][3][4] These can subsequently increase perioperative morbidity and lengthen hospital stay. Intravenous ketamine and alpha agonists are common analgesic adjuncts used in the perioperative setting, however, adverse effects including hallucinations, hemodynamic instability, and excessive sedation can limit utility in some patients. Intravenous infusion of lidocaine, an amide-type local anesthetic, is an emerging technique and is increasingly used for its anti-neuropathic, antihyperalgesic, and anti-inflammatory actions. 1 Lidocaine is on the essential drug list of World Health Organization for both its multiple anesthetic and anti-arrhythmic indications and is considered

Pharmacokinetics of lidocaine and its active metabolites in patients with obesity undergoing laparoscopic bariatric surgery: A prospective clinical study

“…According to the drug concentration-time curves of patients with obesity and normal-weight patients, lidocaine exposure in patients with obesity and normal-weight patients was comparable, and no lidocaine-related AEs, such as tinnitus, perioral numbness, vertigo, seizures, arrhythmia, and atrioventricular block [31], were reported during the entire study. Additionally, lidocaine plasma concentrations in both groups remained below toxic levels (5 µg/mL) [32].…”

Comparative study between the effect of dexmedetomidine and lidocaine infusion on intraoperative analgesic requirement and hemodynamics during craniotomy

“…It is considered a simple intervention that carries minimal risk when administered correctly and can be useful, especially when the regional local anesthetic techniques are not feasible. 24 It can be beneficial for patients in terms of reducing the length of hospital stay and minimizing the incidence of chronic pain related to surgical procedures. 25 Weibel et al, 26 expressed uncertainty about the effect of perioperative lidocaine infusion on opioid consumption and early post-operative pain scores compared with placebo.…”

Preliminary Experience With a Continuous Lidocaine Infusion as an Analgesia Adjunct for Acute Pain Management Following Surgery in Pediatric Patients

“…The majority of this literature pertain to major gastrointestinal procedures, both open and laparoscopic and major orthopedic (spinal) surgery with the demonstration of a reduction in pain scores, decreased opioid use, reduced incidence of postoperative ileus, earlier return of bowel function, decreased incidence of postoperative nausea and vomiting, as well as decreased hospital length of stay [15][16][17][18][19]. Despite significant use and outcome data in adults, the pediatric literature is confined to smaller studies demonstrating the benefit in both the postoperative period as well as for acute and chronic pain of various etiologies [7].…”

“…Although overall opioid-consumption was decreased when patients received lidocaine, there was no significant differences in pain scores or breakthrough morphine consumption. Subsequently, various studies have evaluated the efficacy of lidocaine to improve analgesia and decrease opioid use following major abdominal surgery, spinal surgery, laparoscopic appendectomy, and tonsillectomy [7,[21][22][23][24][25]. Although not uniformly successful based on study design and study cohort numbers, in general, the perioperative infusion of lidocaine in children has demonstrated similar results to those reported in adults including decreased opioid use, decreased pain scores, decreased intraoperative anesthetic requirements, earlier return of bowel function, and decreased pro-inflammatory mediators.…”

“…Shortly after its release for clinical use in 1948, its potential analgesic effects were noted, anecdotal reports were published, and larger clinical trials demonstrated its efficacy in both acute and chronic pain of various etiologies [5]. More recently, several prospective trials in adults have demonstrated its effects on acute post-surgical pain with improvement in pain scores and decreased opioid needs in addition to its anti-hyperalgesic and anti-inflammatory effects [6,7]. However, there remains limited information regarding its use in pediatric-aged patients.…”