Continuous Lidocaine Infusions to Manage Opioid‐Refractory Pain in a Series of Cancer Patients in a Pediatric Hospital

Gibbons, Kathleen; DeMonbrun, Andrea G.; Beckman, Elizabeth J.; Keefer, Patricia; Wagner, Deb; Stewart, Margaret; Saul, D'Anna; Hakel, Stephanie; My, Liu; Niedner, Matthew

doi:10.1002/pbc.25870

Cited by 27 publications

(42 citation statements)

References 16 publications

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“…In a study of 91 patients undergoing procedural sedation no benefit of pre-emptive lidocaine administration (0.5 mg/kgBW bolus) on the injection pain due to propofol could be detected [ 19 ]. Two small studies have examined safety aspects of intravenous lidocaine for the treatment of chronic pain in adolescents [ 20 , 21 ]: Mooney and colleagues reported a small series of 15 patients aged 12–19 years, who had received a total of 58 lidocaine infusions with an infusion rate of up to 60 μg/kg/min (i.e. 3.6 mg/kgBW/h) with no initial bolus.…”

Section: Discussionmentioning

confidence: 99%

“…However, 79% did not experience any side effects at all [ 20 ]. The other recent study retrospectively analyzed 4 patients aged 8–18 years undergoing several treatments with intravenous lidocaine for opioid-refractory cancer pain: Here the authors reported an incidence of side effects such as visual changes or hallucinations, as well as paresthesias during 35% of the treatments [ 21 ]. However, with a median infusion rate of 30 μg/kg/min (i.e.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with intravenous lidocaine in pediatric patients undergoing laparoscopic appendectomy – a retrospective, single-centre experience

et al. 2018

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BackgroundDue to its potential beneficial effects, intra- and postoperative application of intravenous lidocaine has become increasingly accepted over the last couple of years, e.g. in patients undergoing laparoscopic surgical procedures. Based on its beneficial properties, lidocaine was introduced to the standard of care for all pediatric laparoscopic procedures in our institution in mid-2016. In contrast to adult care, scarce data is available regarding the use of perioperative intravenous lidocaine administration in children undergoing laparoscopic procedures, such as an appendectomy.MethodsRetrospective analysis of all pediatric patients undergoing laparoscopic appendectomy at the University Children’s Hospital Zurich in 2016. Perioperative data, as recorded in the electronic patient data management system, were evaluated for any signs of systemic lidocaine toxicity (neurological and cardiovascular), behavioral deterioration, as well as for hemodynamic instability. Additionally, the incidence of postoperative nausea and vomiting, administration of pain rescue medication, time to hospital discharge and to first bowel movement, as well as any postoperative complications were recorded. Starting on 01/07/2016, all patients undergoing laparoscopic surgery received intravenous lidocaine (1.5 mg/kg body weight (BW) bolus after induction of anesthesia followed by continuous infusion of 1.5 mg/kgBW/h). These patients were then compared to children without lidocaine administration who had undergone laparoscopic appendectomy between 01/01/2016 and 30/06/2016.ResultsData of 116 patients was analyzed. Of these, 60 patients received lidocaine. No signs of systemic toxicity, neurologic impairment or circulatory disturbances were noted in any of these patients. A (non-significant) difference in the incidence of emergence delirium was observed (0 cases in the lidocaine group vs. 4 cases in the control group, p = 0.05).ConclusionThis retrospective analysis did not reveal any adverse effects in pediatric patients receiving intravenous lidocaine for laparoscopic appendectomy under general anesthesia. However, further trials investigating beneficial effects as well as pharmacokinetic properties of intravenous lidocaine in children are required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors associated with intravenous lidocaine in pediatric patients undergoing laparoscopic appendectomy – a retrospective, single-centre experience

et al. 2018

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“…In addition, subgroup analysis demonstrated that lidocaine can prevent FIC in both adults and children. And intravenous lidocaine was also reported with safety and tolerability on pediatric patients to relieve pain 18 , 19 . Thus, we advocate that we can also apply lidocaine on children to prevent FIC.…”

Section: Discussionmentioning

confidence: 98%

Prophylactic Intravenous Lidocaine at Different Doses for Fentanyl-Induced Cough (FIC): A Meta-Analysis

Tan

Liu

et al. 2018

Sci Rep

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To evaluate whether different doses of intravenous lidocaine are effective at preventing fentanyl-induced cough (FIC), we searched PubMed, Scopus, Cochrane Library, EMBASE and Web of Science, according to predefined criteria, for all articles published until June 2017. A meta-analysis and subgroup analysis were performed by combining the reported incidence of FIC. The odds ratio (OR) was used as a summary statistic. Eleven articles were included, with 965 patients in the lidocaine group and 745 patients in the control group. A pooled analysis indicated that the overall incidence of FIC was significantly different between the lidocaine group and the control group (OR, 0.27; 95% confidence interval (CI), 0.21–0.35; P < 0.05), as well as between the adult and paediatric subgroups. Sensitivity analysis showed that the results were stable. Subgroup analyses showed that compared to a placebo, both low (0.5–1.0 mg/kg) and high doses of lidocaine (1.5–2.0 mg/kg) were effective at reducing FIC incidence. There was no significant difference between low or high doses of lidocaine. Fentanyl doses added no significant heterogeneity as shown by meta-regression. The findings of this meta-analysis indicate that prophylactic intravenous lidocaine is effective at preventing FIC in both adults and children.

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“…While unrelieved pain changes “the right dose” for opioids, unrelieved pain does not change lidocaine's dose response for producing seizures. For the cases described by Gibbons et al., there appeared to be very impressive analgesic benefit. The authors are to be commended for measuring and reporting plasma lidocaine concentrations.…”

Section: Risk Factors That Warrant Consideration Of Reduced Lidocainementioning

confidence: 88%

“…In this issue of PBC, Gibbons and colleagues report on intravenous lidocaine infusions in four pediatric patients with severe pain due to advanced cancer. All had received appropriate opioid dose escalation and trials of adjuvant analgesics prior to consideration of a lidocaine infusion, and all appeared to have experienced substantially improved pain relief during the infusion and for variable time periods after discontinuation.…”

Section: Risk Factors That Warrant Consideration Of Reduced Lidocainementioning

confidence: 99%

Lidocaine Infusions and Other Options for Opioid‐Resistant Pain Due to Pediatric Advanced Cancer

Berde

Koka

Donado-Rincon

2016

Pediatric Blood & Cancer

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Continuous Lidocaine Infusions to Manage Opioid‐Refractory Pain in a Series of Cancer Patients in a Pediatric Hospital

Cited by 27 publications

References 16 publications

Factors associated with intravenous lidocaine in pediatric patients undergoing laparoscopic appendectomy – a retrospective, single-centre experience

Factors associated with intravenous lidocaine in pediatric patients undergoing laparoscopic appendectomy – a retrospective, single-centre experience

Prophylactic Intravenous Lidocaine at Different Doses for Fentanyl-Induced Cough (FIC): A Meta-Analysis

Lidocaine Infusions and Other Options for Opioid‐Resistant Pain Due to Pediatric Advanced Cancer

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