Efficacy of lidocaine on preventing incidence and severity of pain associated with propofol using in pediatric patients

Abstract

Background:Propofol injection pain was considered as one conundrum during clinical anesthesia. The systematic review about the effect of lidocaine in reducing injection pain among children has not been established. The aim of the study was to systematically evaluate the efficacy and safety of such intervention.Methods:The literature search was performed from the inception to the May 31, 2016 in PubMed, Ovid EMBASE, and Cochrane database. All randomized controlled trials that using lidocaine for propofol injection pain in children were enrolled. The primary outcome included the incidence of injection pain and the incidence of propofol injection pain in different degrees. The data were combined to calculate the relative ratio and relevant 95% confidence interval. A meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement.Results:Data from the included 11 studies indicated that the incidence of injection pain was lower in lidocaine group than the incidence in saline control group and in propofol lipuro (medium- and long-chain triglycerides) group (pain occurrence: 22.1% in lidocaine vs 66.8% in saline, RR with 95% 0.34 [0.26, 0.43], I2 = 38%; 30.5% in lidocaine vs 46.9% in propofol lipuro, RR with 95% 0.68 [0.46, 1.00], I2 = 9%). There was no difference between lidocaine and ketamine/alfentanil both in reducing pain occurrence and in reducing pain severity (pain occurrence: 29.7% in lidocaine vs 25.8% in ketamine, RR with 95% 1.47 [0.16, 13.43], I2 = 94%; 31.0% in lidocaine vs 30.7% in alfentanil, RR with 95% 1.01 [0.69, 1.46], I2 = 11%). And the reported side effects revealed that the safety of lidocaine in pediatric patients was acceptable.Conclusion:Compared with ketamine and alfentanil, lidocaine would be served as one more effective treatment in consideration of its well-matched efficacy, acceptable accessibility, and reasonable safety. However, more high-quality evidences in pediatric patients are necessary.

Effectiveness of intravenous lidocaine in preventing postoperative nausea and vomiting in pediatric patients: A systematic review and meta-analysis

“…However, even in this trial, the measured lidocaine concentration was 0.87 to 4.88 μg.ml -1 [24], which was below the toxicity threshold of 5μg.ml -1 [29]. The dose range of intravenous lidocaine used in our included trials were similar to other previous trials with pediatric patients [10][11][12]. We could not determine the optimal dose from our results.…”

“…Dexamethasone use in certain surgeries is associated with an increased risk of postoperative bleeding [8,38]. Intravenous lidocaine is considered inexpensive and safe, and has been commonly used as an adjuvant for pediatric general anesthesia [10][11][12][13]. Lidocaine has been shown to be effective in preventing opioid-induced cough, laryngospasm, and propofol-induced pain [10][11][12].…”

“…Intravenous lidocaine is considered inexpensive and safe, and has been commonly used as an adjuvant for pediatric general anesthesia [10][11][12][13]. Lidocaine has been shown to be effective in preventing opioid-induced cough, laryngospasm, and propofol-induced pain [10][11][12]. In the included trials, serious adverse events of lidocaine such as seizures, arrhythmia, or allergic reactions did not occur.…”

“…Lidocaine is a common adjuvant for pediatric general anesthesia [9], and some studies have demonstrated that it prevents perioperative adverse events such as opioid-induced cough, laryngospasm, and propofol-induced pain in pediatric surgical patients [10][11][12][13]. There is evidence suggesting that the use of intravenous lidocaine in adult patients undergoing general anesthesia could reduce the incidence of postoperative nausea and vomiting (PONV) [14][15][16].…”

A Prospective Study on the Predictability of Propofol Injection Pain

“…Many agents, such as lidocaine, ketamine, ephedrine, and magnesium, have been used for the prevention of POPI [2,[16][17]. However, the most common application in clinical settings is the application of lidocaine before propofol or an admixture of propofol with lidocaine [18][19]. In our study, we tried to prevent POPI by adding 20 mg of lidocaine to 200 mg of propofol.…”