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

Abstract

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.

Efficacy of intravenous lidocaine infusions for pain relief in children undergoing laparoscopic appendectomy: a randomized controlled trial

“…Our study did not reveal any signs of anaphylaxis, systemic toxicity, circulatory disturbances or neurological impairment. This observation is consistent with other trials [3,5,6,14,15,22] investigating the issue.…”

“…The aforementioned toxic thresholds are far above the concentrations recorded in El-Deeb's protocol of infusion administration. In light of these considerations as well as other data available in the literature [6,22] the proposed scheme of dosage was regarded as safe and chosen for investigation in our study. It was also approved by the Ethics Committee of the Medical University of Warsaw.…”

“…While it shows promise for use in the pediatric population [5,6], limited evidence is available and metaanalyses are inconclusive [7,8]. This study was planned to evaluate the efficacy of continuous intravenous infusion of lidocaine in reducing opioid consumption during and after laparoscopic appendectomy in children.…”

Systemic Lidocaine Infusion for Post-Operative Analgesia in Children Undergoing Laparoscopic Inguinal Hernia Repair: A Randomized Double-Blind Controlled Trial

“…This treatment attenuated the increase in serum cortisol levels, reduced daily fentanyl requirements, hastened the return of bowel functions, and reduced the length of the hospital stay for the children [12]. The other published study indicated that lidocaine (1.5 mg kg −1 over five minutes followed by 2 mg kg −1 h −1 ) decreased postoperative vomiting in children undergoing an elective tonsillectomy [13]. The serum’s lidocaine concentration was measured in both studies, and in no cases were toxic plasma concentration, neurological disturbances (seizures, numbness, tingling, or paresthesia), or cardiovascular collapses detected in any of the participants [12,14].…”

“…The serum’s lidocaine concentration was measured in both studies, and in no cases were toxic plasma concentration, neurological disturbances (seizures, numbness, tingling, or paresthesia), or cardiovascular collapses detected in any of the participants [12,14]. University Children’s Hospital Zurich, Switzerland implemented the protocol of intravenous lidocaine infusion for children undergoing laparoscopic surgery, and adverse effects were not reported [13]. According to the Cochrane analysis, in adults undergoing open or laparoscopic abdominal surgery, a continuous lidocaine infusion rate of 1.5 mg kg −1 h −1 reduced pain immediately after, and until 24 h, with no increased risk of adverse effects such as death, arrhythmias or signs of lidocaine toxicity [15].…”